REGULATION  OF  TEETH 


TREATMENT  OF  JAW  FRACTURES. 


EDWARD  H.  ANGLE,  D.D.S. 


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THE   ANGLE   SYSTEM 


REGULATION  AND  RETENTION 
OF  THE  TEETH, 


TREATMENT  OF  FRACTURES  OF  THE  MAXILLil. 


Fourth  Edition,  Revised  and  Enlarged. 


With  Oxe  Hundred  and  Thirteen  Illustrations, 


EDWARD  H.  ANGLE,  D.D.S., 

FoRMKR   Professor   of   Histology,  Orthodontia,  and    Comparative    Anatomy   of 

THE  Teeth,  in  the  Dental   Department  of    the  University    of   Minnesota  ; 

Professor    of    Orthodontia    in    the    American    College    of    Dental 

Surgery,  Chicago,  III.;    Surgeon  to  the  Asbury  Hospital  in 

Minneapolis.  Minn.,  and  Surgeon  foe  the  Treatment 

of  Fkactcres  of  the  Maxilla:  to  the  Great 

Northern  Rail'stay. 


PHILADELPHIA: 

THE  S.  S.  WHITE  DENTAL  MFG.  CO. 

1895. 


Copyrighted  1894,  by  Edward  H.  Angle,  D.D.S.,  Minneapolis,  Minn. 


PREFACE  TO  THE  FOURTH  EDITION. 


The  many  letters  of  high  approval  received  from  practition- 
ers in  this  and  other  countries ;  the  rapidity  with  which  it  has 
passed  through  three  editions ;  its  translation  into  foreign  lan- 
guages ;  its  influence  as  shown  in  the  modification  of  much  that 
has  been  written  by  others  since  its  first  publication :  are  alto- 
gether gratifying  evidences  of  the  general  popularity  which 
this  system  has  already  attained.  Many  new  combinations  that 
simplify  and  facilitate  treatment,  together  with  several  new  and 
important  improvements,  characterize  the  fourth  edition.  That 
these  modifications  and  additions  will  prove  advantageous  and 
satisfactory  to  the  busy  practitioner,  student,  and  teacher,  is  the 
earnest  wish  of  the  author. 

Edward  H.  Angle. 

Dayton  Building, 
Minneapolis,  Minnesota,  December,  1894. 


TABLE  OF  CONTENTS. 


TART  L 
ORTHODONTIA. 


CHAPTER  I. 

General  Consideration  of  Orthodontia 
Set  No.  1  Angle's  Appliances,  Description  of  . 
Set  No.  2  Angle's  Appliances,  Description  of  . 
Extras,  Description  of      ....         . 


PAax 

.  7 
.  9 
.  10 
.     11 


CHAPTERfll. 


Teeth  Bands,  Adjustment  of 
Litratures  .... 


CHAPTEPv  III. 

Tools  Used  in  Operating  Appliances 

CHAPTER  IV. 
Soldering  ........ 

CHAPTER  V. 
Models 


CHAPTER  VI. 

EORCES    FOR    TOOTH-MOTEMENT. 


Direction  of 
Backward  in  Line  of  the  Arch 
Forward  in  Line  of  the  Arch 
Outward  in  Line  of  the  Arch 
Inward  in  Line  of  the  Arch 
Rotation    .... 
Double  Rotation 
Elevation .... 
Expansion 

CHAPTER  VII. 

Practical  Cases. 
Illustrations  and  Treatment  of  Miscellaneous  Cases 
Jumping  the  Bite     ...... 

Excessive  Protrusion  of  the  Upper  Teeth 
Excessive  Protrusion  of  the  Lower  Teeth 


CHAPTER  VIII. 


General  Sugtrestions 


13 
17 

20 
20 
23 


26 
29 
30 
35 
36 
38 
39 
42 


47 
62 
66 
73 

80 


6 


TABLE    OF    CONTENTS. 


PAET  II. 
FRACTURES  OF  THE  MAXILLA. 

CHAPTEE  I. 

Treatment  of  Fractures  of  the  jNIaxillce 84 

CHAPTEE  II. 
rinal  Suggestions  on  Fractures 99 


PART  I. 

ORTHODONTIA. 


CHAPTER    I. 

THE    ANGLE    SYSTEM    OF    TEETH-KEGULATION    AND    RETENTION. 

It  is  often  asserted,  even  by  some  authoritative  writers  upon 
the  treatment  of  dental  irregularities  (Orthodontia),  that  wo  fixed 
system  of  appliances  should  or  can  be  depended  upon;  that  each 
case  so  differs  from  all  others  as  to  require  some  new  appliance 
peculiai'ly  suited  to  that  particular  case,  and  that  only. 

Upon  this  theory,  success  would  demand  not  only  skill  in 
operation,  but  the  constant  exercise  of  inventive  genius.  The 
inventive  faculty  is  rather  a  natural  gift  than  an  acquirement, 
and  can  be  exercised  successfully  only  by  the  favored  few,  while 
even  the  greatest  inventor  must  be  an  experimenter.  Hence 
all  treatment  upon  such  theory  must  be,  and  in  fact  has  ever 
been,  tedious,  costly,  and  of  doubtful  result. 

It  is  probable  that,  for  the  foregoing  reasons.  Orthodontia  has 
never  received  that  attention,  even  in  the  schools  of  dentistry, 
that  its  importance  demands. 

The  author  believes,  and  has  proven,  that  it  is  not  only  possi- 
ble, but  practicable,  to  systematize,  classify,  and  provide  ready- 
made  regulating  appliances,  reducing  them  to  a  few  simple 
forms,  to  meet  by  their  combinations  the  requirements  in  all 
varieties  of  cases  susceptible  of  treatment. 

The  present  purpose  is  to  submit  such  a  sj'stem,  explain  the 
character  and  use  of  the  appliances,  and  show  by  cuts  of  models 
of  actual  cases  the  methods  of  treatment.  The  appliances 
shown  in  Sets  ISTo.  1  and  No.  2,  and  the  few  extra  pieces  follow- 
ing them,  have,  in  fact,  fully  and  readily  met  the  requirements 

7 


8  THE    ANGLE    SYSTEM. 

of  every  case,  while  combinations  of  them,  other  than  those 
hereinafter  shown,  have  rarely  been  necessary. 

The  author  will  always  be  glad  to  afford  the  profession  ample 
opportunity  to  inspect  his  collection  of  models  of  actual  cases 
treated,  which  correctly  show  each  stage  of  the  operation  from 
beginning  to  completion;  and  he  feels  sure  that,  for  variety  of 
difficulties  to  be  overcome,  facility  and  certainty  of  operation, 
and  success  in  results,  all  clearly  shown  by  the  models,  this  col- 
lection will  compare  favorably  with  any  other  in  the  world. 

The  claim  made  by  many  authors,  teachers,  and  practitioners, 
that  each  dentist  should  from  raw  materials  make  his  own 
appliances  for  use  in  Orthodontia,  is  quite  as  unreasonable  and  ' 
impractical  as  to  require  him  to  make  all  his  own  instruments 
for  use  in  other  branches  of  dentistry ;  and  the  time  spent  by 
the  student  in  the  dental  schools  to  acquire  constructive  knowl- 
edge and  skill  for  either  purpose  could  and  should  be  more 
profitably  spent  in  the  study  of  actual  cases,  and  of  the  applica- 
tion of  established  forms  of  appliances  and  instruments  made 
by  skilled  experts,  who  have  become  so  not  only  from  natural 
ability,  but  by  intense  study  and  long  practice. 

The  author  claims  that  his  system  can  be  easily  taught  and 
learned  in  the  dental  schools;  that  the  dentist  may  quickly 
acquire  a  complete  knowledge  of  it;  and  that  the  practice  of 
Orthodontia,  instead  of  being  regarded,  as  heretofore,  tedious 
and  unsatisfactory,  something  to  be  avoided  rather  than  sought 
for,  may  be  made  one  of  the  most  useful,  satisfactory,  and  lucra- 
tive branches  of  dentistry. 

Dr.  Farrar  seems  also  to  have  become  convinced  of  the  prac- 
ticability of  what  has  been  heretofore  stated,  for  he  says  in  voL 
XX,  page  20,  of  the  Dental  Cosmos, — 

"  It  has  for  some  time  been  evident  to  me  (though  by  most 
people  thought  to  be  impracticable)  that  the  time  will  come 
when  the  regulating  process  and  the  necessary  apparatus  will 
be  so  systematized  and  simplified  that  the  latter  will  actually  be 
kept  in  stock,  in  parts  and  wholes,  at  dental  depots,  in  readiness 
for  the  profession  at  large,  so  that  it  may  be  ordered  by  cata- 
logued numbers  to  suit  the  needs  of  any  case ;  so  that  by  a 
few  moments'  work  at  the  blow-pipe  in  the  laboratory  the 
dentist  may  be  able,  by  uniting  the  parts,  to  produce  any  ap- 
paratus, of  any  size  desired,  at  minimum  cost  of  time  and 
money." 


TEETH-REGULATION   AND    RETENTION.  V 

Section  L  The  limits  of  this  book  will  not  permit  of  an 
exhaustive  treatise  on  the  subject  of  Orthodontia  generally,  and 
the  author  will  therefore  confine  himself  to  the  description 
and  use  of  the  appliances  and  methods  of  treatment  which  he 
has  found  so  satisfactory  in  an  extensive  practice,  believing  that 
most  practitioners  will  succeed  best  by  adopting  one  complete 
system  and  thoroughly  familiarizing  themselves  with  the  same. 

To  those  who  may  desire  to  study  the  subject  in  all  its  rela- 
tions, together  with  the  history  of  methods  and  appliances  in 
genera],  he  would  recommend  the  excellent  treatises  of  Drs. 
Guilford  and  Kingsley. 

Fig.  1. 


Skt  No.  1.    Angle's  Appliances. 


It  is  essential  to  a  clear  comprehension  of  the  manifold  uses 
of  the  several  appliances  to  which  frequent  references  will  sub- 
sequently be  made  that  their  names,  shapes,  sizes,  and  indicating 
numbers  or  letters  should  be  carefully  noted  and  kept  in  mind. 
Every  part  is  important;  none  can  well  be  omitted. 

For  convenience  of  description  and  designation,  they  are 
divided  into  Sets  l^o.  1  and  ISlo.  2,  together  with  a  few  extra 
parts.  Any  piece,  however,  may  be  ordered  separately,  as  all 
of  a  kind  are  interchangeable,  and  each  accurately  fits  the  part 
to  which  it  belongs. 

The  Set  No.  1,  Fig.  1,  consists  of  the  retaining-wire  G,  and  ten 
sections  of  retaining  and  anchor  pipes  R,  R,  which  will  closely 
slide  on  wire  G.     The  traction-screw  A  has  its  smooth  end  bent 


10  THE    AXGLE    SYSTEM. 

for  insertion  in  the  short  tube  D.  When  the  nut  is  against  the 
A  end  of  the  long  tube,  and  that  tube  soldered  to  a  tooth-band, 
turning  forward  the  nut  will  pill  the  hook  in  the  tube  D  when 
that  has  been  soldered  to  a  tooth-band;  if  the  nut  is  against  the 
other  end  of  the  long  tube,  it  will  push  D  and  its  tooth-band. 
B,  C  is  a  like  but  smaller  combination,  of  the  same  diametric 
size  as  the  jack-screw  J.  When  the  tube  of  J  is  soldered  to  a 
tooth-band  on  one  tooth,  it  will  'push  directly  against  a  notched 
tooth-band  or  a  tooth.  E  is  a  longer  piece  of  the  tube  than  is 
shown  on  J,  with  which  a  longer  jack-screw  may  be  made  when 
required.  The  thinner  coil  of  band-material  is  seen  at  F,  the 
thicker  at  H,  either  of  which  is  sufficient  to  make  about  twenty- 
five  tooth-bands.  The  rotating  levers  L,  three  sizes  of  two 
each,  and  wrench  W,  complete  the  set,  which  will  suffice  for 
several  reg'ulatino;  cases. 

It  will  .thus  be  seen  that  the  appliances  of  this  set  are  very 
simple  and  few  in  number,  being  limited  practically  to  three, — 
viz,  the  lever  for  rotating,  the  screw  for  pushing,  and  the  trac- 
tion-screw for  pulling ;  and  the  other  pieces  for  the  purpose  of 
securing  attachments.  Aside  from  their  advantages  of  sim- 
plicity, efficiency,  and  cleanliness,  their  intelligent  application 
will  eflfect  a  stationary  anchorage  upon,  a  positive  movement  of, 
and  afterward  a  firm  retention  of,  the  teeth. 

SECTiOiSr  II.  Set  ISTo.  2  is  designed  for  the  treatment  of  a  special 
class  of  irregularities,  or  that  prognathic  type  known  as  excessive 
protrusion  of  the  upper  incisors.  The  plan  of  this  set  (No.  2) 
differs  principally  from  that  of  Set  E'o.  1  in  that  the  anchorage 
is  occipital,  or  by  means  of  a  cap  covering  the  back  of  the  head 
(as  seen  in  Fig.  3),  to  which  heavy  elastic  bands  are  attached 
and  received  by  the  hooks  upon  the  ends  of  traction-bar  A. 

The  wire  arch  B  encircles  the  dental  arch  and  bears  against 
the  protruding  teeth,  receiving  the  necessary  pressure  from  the 
standard  in  the  center  of  the  traction-bar.  D,  I)  represent 
adjustable  anchor  clamp-bands  and  pipes  for  securing  the  ends 
of  the  arch  B  upon  the  molar  teeth,  while  C,  C  represent  plain 
bands  for  holding  in  position  upon  the  teeth  the  anterior  part  of 
the  arch,  as  shown  in  Fig.  84.  C  is  a  coil  of  band-material, 
from  which  the  bands  C,  C  are  to  be  made  for  each  case.  This 
coil  is  the  same  as  F,  Fig.  1,  Set  No.  1. 

E,  E  represent  small  rubber  rings  to  retain  the  teeth  during 
intervals  of  rest,  when  not  wearing  the  head-cap  and  traction - 
bar,  also  shown  in  Fig.  84. 


TEETH-REGULATION    AND    RETENTION. 
Fig.  2. 


11 


Set  No.  2,  Angle's  Appliakces. 


Fig.  3. 


Extra  Parts. 

Section  III.  Fig.  4  shows  an  extra  wire  expansion-arch.  Its 
use  is  directly  the  opposite  that  of  wire  arch  B',  in  that  it  is  used 
for  expanding  the  arch,  and  is  to  be  known  as  the  expansion-arch 
E.  Tlie  ends  of  this  arch  are  threaded  and  provided  with  nuts. 
By  putting  the  threaded  ends  into  the  anchor-tubes  upon  the 
clamp-bands  T),  Set  No.  2,  secured  to  anchor-teeth,  the  arch  ma}' 
be  pushed  forward  by  tightening  the  nuts,  thus  exerting  force 


12 


THE    ANGLE    SYSTEM. 


against  other  teeth  which  may  have  been  secured  to  the  arch  by 
means  of  ligatures  or  bands. 

[This  arch  is  not  included  in  Set  No.  2,  but  must  be  ordered 
separately,  as  also  the  extra  bands  and  tubes  D,  Fig.  2,  with 
which  it  is  always  used.] 

Fig.  4. 


In  Fig.  5  is  shown  a  metal  cap  covering  the  chin,  and  in  con- 
nection with  the  head-gear  and  heavy  elastic  bands  it  is  used  in 
the  retraction  of  the  inferior  maxilla,  as  shown  in  the  figure. 


Fig. 


This  cap  is  light,  nicely  made,  highly  polished,  and  will  fit  all 
cases,  as  it  is  necessary  for  fit  to  be  only  approximately  accurate. 
A  layer  of  absorbent  cotton  should  always  be  placed  between 
the  metal  and  the  chin  while  it  is  beino;  worn. 


TEETH    BANDS.  13 

Fig.  6  represents  adjustable  clamp-bands  for  encircling  the 
molars  and  bicuspids,  to  which  are  attached  the  various  appli- 
ances. Nos.  3  and  4  have  pins  soldered  to  their  sides,  to  which 
ligatures  may  be  attached.  This  style  of  band  is  especially  de- 
signed for  the  treatment  of  fractures  of  the  maxillae,  and  its  use, 
therefore,  is  fully  shown  in  that  portion  of  this  work  devoted  to 

Fig.  6. 


No.  1— Bicuspid.         No.  2— Molae.         No.  3— Bicuspid. 

such  treatment,  but  it  is  also  useful  in  the  regulation  of  teeth, 
as  described  later. 

The  head-cap  represented  as  covering  the  back  of  the  head 
(Fig.  5)  is  also  an  extra.  It  is  beautifully  made  and  presents  a 
very  neat  appearance,  is  strong,  durable,  and  may  be  quickly 
adjusted  to  fit  any  size  of  head.  As  auxiliaries  to  the  above 
appliances,  ligatures  made  from  waxed  floss  silk,  or  wire,  are 
necessary. 


CHAPTER  11. 

BANDS    AND    LIGATURES. 

Section  I.     Teeth  Bands. 

In  this  system  two  kinds  of  bands  are  used  for  attaching  the 
appliances  to  the  teeth  :  the  plain  or  soldered  band  (C,  C,  Fig.  2), 
and  the  clamp  or  adjustable  band  (Fig.  6).  The  plain  band  is 
made  from  the  coil  of  band-material,  F  and  H,  Fig.  1.  F  is 
thinner  and  narrower  than  H,  and  is  generally  used  on  the  lower 
incisors  or  upper  laterals,  or  where  a  delicate  band  is  desirable. 
It  is  extremely  thin,  being  only  .003  of  an  inch  in  thickness,  so 
that  it  will  readily  pass  between  the  teeth  and  occupy  but  little 
space ;  yet  the  material  is  so  strong  that  it  will  resist  all  neces- 
sary strain  if  not  overheated.  H  is  .004  of  an  inch  in  thick- 
ness, and  is  used  in  making  the  bands  for  the  central  incisors 
or  cuspids.     Each  coil  is  suifieient  for  about  twenty-five  bands. 

I  have  long  discontinued  the  use  of  plain  bands  upon  the 


14  THE    ANGLE    SYSTEM. 

molars  and  bicuspids,  for  it  is  impracticable  to  fix  and  cement 
them  on  these  teeth  (owing  to  their  unfavorable  shapes  and 
positions),  so  that  they  will  not  soon  loosen  under  the  severe 
strain  to  which  they  are  subjected. 

The  adjustable  clamp-bands,  Wos.  1  and  2,  are  far  more  con- 
venient and  desirable,  being  easily  and  quickly  clamped  and  bur- 
nished to  fit  the  tooth  so  that  they  will  not  loosen,  and  cement  is 
unnecessary.  Another  advantage  is  in  their  ready  removal  and 
replacement,  should  changes  in  their  attachments  be  necessary. 

These  bands  are  made  in  two  sizes,  which  have  been  deter- 
mined by  the  accurate  measurement  of  a  large  number  of  bi- 
cuspids and  molars.  They  will  fit  all  teeth  of  normal  size,  and 
may  be  enlarged  to  accommodate  teeth  of  unusual  size  by  beat- 
ing the  first  third  or  half  of  the  screw  flat  over  the  horn  of  an 
anvil ;  to  reduce  the  size  for  abnormally  small  teeth  it  is  only 
necessary  to  cut  the  band  midway  of  the  flat  portion,  lap  the 
desired  distance,  and  resolder. 

In  adjusting  them  to  the  teeth  extreme  care  should  be  exer- 
cised not  to  crimp,  tear,  or  injure  them  in  any  way.  If  there  is 
not  space  to  admit  their  passage,  it  should  be  provided;  then 
with  a  little  patience  they  may  be  easily  worked  over  the  crown 
to  any  desired  point  with  the  fingers  alone.  ISTever  be  content 
to  stop  when  a  band  is  only  half  or  two-thirds  over  the  crown, 
as  the  entire  strain  is  then  borne  by  that  partial  portion  of  the 
band,  and  breaking  is  almost  certain  when  the  nut  is  turned. 
Carefully  work  the  band  to  exactly  the  position  desired,  then 
tighten  the  nut  and  burnish  alternately  until  the  fit  is  accurate. 
Burnishing  is  important  not  only  to  enhance  the  fit,  but  to 
harden  and  strengthen  the  material. 

As  the  bands  are  so  important  in  this  system,  and  the  making 
and  fitting  of  the  plain  bands  the  most  difficult  part  in  the  opera- 
tion of  any  of  the  combinations,  I  would  recommend  that  accu- 
racy and  care  be  observed  in  each  step  in  the  operation.  First, 
in  order  to  insure  perfect  uniformity  in  annealing,  the  coil  of 
band-material  should  be  heated  and  plunged  in  dilute  sulphuric 
acid  before  cutting  the  vdre  ligatures  encircling  it.  A  loop  in 
the  band-strip  is  then  slipped  over  the  tooth  to  be  banded,  and 
worked  up  or  down  upon  the  crown  to  the  exact  point  it  is  to- 
occupy  when  completed.  It  is  held  between  the  thumb  and 
finger,  and  tightly  drawn  around  the  tooth  against  that  side  on 
which  the  union  is  to  be  made.     While  thus  firmly  held  it  is 


TEETH    BANDS.  15 

grasped  between  the  flattened  beaks  of  a  pair  of  strong  pliers, 
and  pinched  or  drawn  tightly  about  the  tooth,  a  burnisher  be- 
ing applied  at  the  same  time  to  make  it  conform  still  more 
accurately  to  the  shape  of  the  tooth.  It  is  important  that  the 
beaks  of  the  pliers  should  be  smooth  and  fit  together  accurately. 
It  is  then  remoA^ed  and  presents  the  ^ 

appearance  ot  1*  ig.  7.  A  piece  ot 
clean  silver  solder,  about  one-eighth 
of  an  inch  square,  wet  with  borax 
cream,  is  now  placed  between  the 
jaws  at  the  junction  and  held  there  by  being  pressed  together 
with  the  delicate  soldering  pliers  E,  Fig.  8A.  It  is  then  held  over 
a  tine,  sharp  soldering  flame.  When  soldered,  the  inner  surface 
of  the  band  should  present  one  continuous,  even  surface ;  any 
other  union  is  imperfect  and  should  not  be  used. 

The  band  is  now  ready  for  any  attachments  which  may  be 
made,  the  untrimmed  ends  of  the  band  serving  the  useful  pur- 
pose of  a  handle  for  holding  the  band  in  the  flame  and  in  con- 
tact with  the  piece  to  be  attached,  while  soldering,  as  in  G  and 
H,  Fig.  21.  After  the  attachment  has  been  made  the  ends  of 
the  bands  are  trimmed  ofi',  leaving  it  long  or  short  as  desired. 

If  a  niche  is  to  be  formed  as  in  A,  Fig.  21,  or  C,  C,  Fig.  2, 
the  ends  are  left  about  one-sixteenth  of  an  inch  long;  but  if 
not  to  serve  as  a  means  of  attachment  they  may  be  trimmed 
still  shorter,  though  it  is  never  desirable  to  trim  them  even  with 
the  surface  of  the  band.  These  united  ends  may  be  further 
strengthened  by  an  extra  piece  of  the  band-material  held  be-- 
tween  the  jaws  at  the  junction  when  soldering. 

It  should  now  be  boiled  in  a  few  drops  of  dilute  sulphuric 
acid  in  a  small  test-tube  or  other  suitable  vessel,  after  which  it 
is  washed  and  dried.  The  tooth  should  now  be  protected  from 
moisture  by  a  small  roll  of  cotton  or  bibulous  paper,  the  surface 
of  the  tooth  cleansed  by  a  pledget  of  alcohol  or  ether,  and  dried 
with  the  chip-blower.  A  suflicient  quantity  of  oxyphosphate  of 
zinc  to  fill  the  band  is  now  mixed  to  a  creamy  consistency, 
then  carried  on  the  end  of  the  fino;er  to  the  tooth,  forcins;  the 
cement,  as  well  as  band,  on  to  the  tooth.  By  carefully  working 
with  the  fingers  alone,  the  band  is  forced  nearly  to  its  desired 
position,  which  may  be  completed  by  a  few  gentle  taps  from  the 
mallet  and  band-driver  (L  and  M,  Fig.  8B).  The  burnisher  is 
now  quickly  applied  and  the  surplus  cement  wiped  ofl".    If  the 


16  THE    ANGLE    SYSTEM. 

operation  has  been  carefully  performed  the  band  will  fit  with  the 
most  glove-like  accuracy  at  every  point,  so  that  it  will  occupy 
the  least  possible  space,  which  is  very  desirable  in  most  cases. 
The  attachment  will  be  so  firm  that  the  annoyance  of  loosening 
will  be  obviated.  Only  a  perfectly-fitting  band  can  be  firmly 
attached.  If  the  band  is  defective  in  any  particular,  as  too  large, 
weakened  by  crimping,  or  slightly  torn  when  driven  in  position, 
it  should  be  immediately  condemned,  and  a  more  perfect  one 
substituted,  for  sooner  or  later  it  will  surely  fail  and  cause 
annoyance. 

It  is  most  important  that  the  operation  of  banding  should  be 
thoroughly  performed,  and  at  the  first  operation,  or  before  the 
tooth  has  become  tender  by  being  moved. 

In  making  the  band,  it  is  desirable  that  all  the  attachments 
which  will  be  needed,  both  in  moving  and  retaining,  shall  be 
added  before  first  setting  the  band,  in  order  that  the  subsequent 
pain  and  trouble  of  loosening  and  resetting  may  be  avoided. 

A  little  experience  (and  I  would  recommend  also  practice 
upon  teeth  out  of  the  mouth)  will  soon  enable  the  operator  to 
quickly,  easily,  and  perfectly  band  any  tooth. 

In  cases  where  the  teeth  are  crowded  firmly  together,  leave 
the  band  in  position  upon  the  tooth  for  a  few  hours,  or  over 
night,  before  final  cementing.  Sufficient  space  will  thus  be 
gained  so  the  band  may  be  readily  cemented  without  crimping. 

A  cuspid  is  the  most  difficult  of  any  of  the  teeth  to  band,  but 
by  forming  a  seam  on  the  lingual  slope  and  firmly  burnishing 
the  outer  surface  while  it  is  being  pinched,  an  accurate  fit  can 
in  most  instances  be  made ;  or  by  making  the  union  on  the 
labial  surface,  and  pinching  a  fold  on  the  lingual  slope  and  again 
soldering,  an  accurate  fit  may  be  obtained. 

After  a  band  has  been  set,  and  the  cement  thoroughly  hard- 
ened, the  band  should  be  carefully  polished  and  burnished,  as  it 
is  well  known  that  discoloration  is  less  liable  with  a  smooth, 
polished  surface  than  a  rough  one.  I  have  found  nothing  nearly 
so  eft'ective  for  removing  the  superfluous  cement  and  polishing 
the  surface  of  the  band  as  little  leather  polishing-wheels. 

When  desirable  to  loosen  the  band,  never  attempt  to  do  so 
with  forceps,  as  the  shock  to  the  tooth  and  danger  to  the  enamel 
are  too  great  to  be  risked.  Cut  the  band  by  grinding  it  with  a 
suitably-shaped  wheel,  carefully  supporting  the  tooth  at  the 
same  time. 


LIGATURES.  17 

Section  II.     Ligatures. 

Of  the  various  materials  employed  for  ligatures  I  now  use  but 
three.  First,  the  rubber  ligature,  which  is  best  made  by  punching 
with  a  rubber-dam  punch  a  hole  through  heavy  rubber-dam,  or 
in  a  thin  elastic  band,  and  then  trimming  the  outside  down  to 
the  desired  size ;  second,  waxed  floss  silk ;  third,  wire.  Each 
possesses  advantages  in  certain  cases,  but  on  account  of  the 
cleanliness,  strength,  and  ease  with  which  force  may  be  exerted 
by  twisting  its  ends,  the  wire  ligature  is  decidedly  preferable. 
The  proper  sizes  of  wire  are  ITos.  26  and  28,  and  it  should  be 
annealed  brass  or  copper.  It  may  be  procured  of  any  wholesale 
hardware  dealer,  or  will  be  supplied  if  desired.  Spring  wire 
will  not  answer. 

The  best  way  to  adjust  a  wire  ligature  is  to  cut  a  piece  from 
the  spool,  eight  or  ten  inches  long,  or  sufficient  to  be  grasped 
firmly  with  the  hands.  It  is  made  to  encircle  the  tooth  and 
arch  by  passing  it  through  the  interdental  spaces.  The  ends 
are  grasped  firmly,  drawn  around  the  tooth  and  appliance,  and 
twisted, — never  more  than  two  twists  at  first.  The  surplus  wire 
is  then  cut  off  with  the  shears  (C,  Fig.  8  A),  leaving  the  ends 
one-eighth  of  an  inch  long,  then  curling  them  around  under  the 
arch,  as  shown  correctly  only  in  Figs.  28,  67,  and  73.  It  is  very 
important  that  this  point  be  remembered,  for  by  observing  this 
special  way  of  providing  for  the  sharp  ends,  a  smooth,  easy  sur- 
face is  presented  to  the  lip.  ^N'ever  "attempt  to  bend  the  twisted 
portion  of  the  ligature  out  of  the  way,  as  by  so  doing  the  liga- 
ture will,  in  almost  every  instance,  be  broken.  In  tightening 
the  ligature,  I  find  a  very  excellent  plan  is  to  gently  press  the 
tooth  and  arch  between  the  roughened  beaks  of  pliers  B,  Fig.  8 
A,  while  the  twist  is  being  made  with  pliers  A,  Fig.  8  A.  Great 
force  should  never  be  exerted  in  twisting  the  wire,  or  breaking 
will  surely  follow.  It  should  also  be  remembered  that  the 
spring  of  the  wire  arch,  when  used  in  connection  with  the  wire 
ligature,  is  constantly  acting,  so  that  as  a  rule  tightening  a  liga- 
ture should  be  done  only  occasionally. 

The  different  styles  of  ligatures  are  well  shown  in  Fig.  28, 
and  should  be  carefully  studied. 

2 


18 


THE    ANGLE    SYSTEM. 
Fig.  8  A. 


LIGATURES. 
Fig.  8  B. 


19 


20  THE    ANGLE    SYSTEM. 


CHAPTER   III. 

TOOLS. 

FoK  uniting  the  different  parts  of  the  appliances  to  form  the 
various  combinations,  and  placing  them  in  position  upon  the 
teeth,  only  a  few  tools  are  necessary,  but  it  is  important  that 
they  should  be  of  the  best  selection.  A  pair  of  shears,  C,  Fig. 
8  A,  for  trimming  soldered  bands  and  cutting  wire  ligatures,  etc. 
A  pair  of  pliers,  E,  Fig.  8  A,  used  in  holding  bands  and  some 
of  the  small  parts  while  soldering,  is  the  most  suitable  of  any 
made,  on  account  of  their  fine  delicate  proportions.  Coarse 
pliers  should  never  be  used,  as  they  absorb  too  much  heat,  and 
with  them  fine,  delicate  soldering  cannot  be  accomplished  with- 
out danger  of  overheating. 

A  second  pair,  D,  Fig.  8  A,  for  placing  pieces  of  the  solder  in 
position.  A  pair  of  wire-cutters ;  I  prefer  the  stjde  shown  in  F, 
Fig.  8  A. 

Two  pairs  of  pliers  for  forming  the  plain  band,  twisting  wire 
ligatures,  etc.  Those  shown  at  A  and  B,  Fig.  8  A,  are  most  ex- 
cellently adapted. 


CHAPTER   IV 

SOLDERING. 


H,  Fig.  8  B,  shows  the  author's  forceps  for  stretching  wire, 
which  will  be  found  very  useful  in  the  regulation  of  teeth.  Its 
peculiar  form  renders  it  easy  of  application  in  any  part  of  the 
mouth.  It  is  adapted  to  the  wire  G,  Set  ISTo.  1,  and  should  never 
be  used  for  stretching  hard  or  large-sized  wires.  A  little  experi- 
ence in  its  use,  and  the  operator  will  become  skillful,  and  will 
probably  be  surprised  to  see  how  much  can  be  accomplished  in 
the  regulation  of  teeth  by  its  use.  A  little  anvil  is  also  quite 
useful,  and  the  very  hand}'  and  ingeniously  constructed  pattern 
shown  at  K,  Fig.  8  B,  will  be  found  the  most  suitable. 

In  uniting  the  parts  of  the  appliances  with  solder,  a  fine 
sharp  flame  from  a  stationary,  self-acting  blow-pipe  is  most 
desirable,  as  then  both  hands  are  free  and  can  be  used  in  hold- 
ing the  pieces.    ITotwith standing  many  ingenious  spring-clamps 


SOLDERING.  21 

and  devices  have  been  invented  for  holding  such  small  work 
while  soldering,  yet  I  greatly  prefer  holding  them  with  the  fin- 
gers, as  it  is  so  much  easier  and  simpler,  steadying  the  hands 
by  touching  the  fingers  together  as  shown  in  Figs.  9  and  10. 

The  metal  of  which  these  appliances  are  made  is  most  favor- 
able for  soldering  in  this  way,  it  being  so  extremely  poor  a  con- 
ductor of  heat  that  all  such  attachments  as  E,  F,  I,  H,  and  K, 
Fig.  20,  can  readily  be  held  with  the  fingers  without  hardly 
noticing  a  change  in  the  temperature,  provided  the  flame  is 
suitable.  I  prefer  the  Herapath  blow-pipe,  as  shown  in  G, 
Fig.  8  B.  A  building  where  compressed  air  is  furnished  and 
conducted  through  pipes  to  all  rooms,  the  same  as  gas,  the  pres- 
sure being  constant,  even,  and  steady,  is  preferable;  yet  the 
ordinar}'  foot-bellows  answers  very  well. 

Fig.  9. 


All  the  small  tubes  are  best  held  by  slipping  them  on  to  the  end 
of  an  excavator  shank  or,  what  is  just  the  ideal,  one  of  Gates's 
nerve-drills  after  the  cutting-point  has  been  broken  oif.  It  is  so 
slender  that  but  little  of  the  heat  is  absorbed.  Two  of  these 
handles  may  be  employed  when  a  couple  of  the  small  tubes  are 
soldered,  as  R,  C,  Fig.  44,  or  the  pliers  may  be  used  for  holding 
one  of  them.     (See  Fig.  10.) 

I  should  judge  it  not  difficult  to  learn  this  method  of  solder- 
ing, as  most  of  my  students  seem  to  learn  it  readily.  The  only 
point  which  at  all  may  perplex  the  beginner  is  to  hold  the  pieces 
immovable  just  at  the  time  solder  is  congealing,  but  this  can 
be  done  by  touching  the  fingers  of  the  opposite  hand  in  order 
to  steady  and  prevent  all  motion  at  the  point  of  union,  and  at 
the  same  time  holding  the  pieces  gently,  not  rigidly,  just  as  a 
good  penman  holds  a  pen.     After  a  little  practice  any  of  the 


22 


THE    ANGLE    SYSTEiVI. 


combinations  shown  in  this  book  may  be  easily  made  in  a  very- 
few  minutes.  All  of  the  various  attachments  by  solder  shown 
in  Figs.  20  and  21  are  made  in  this  way.  In  such  attachments 
as  E,  F,  H,  and  K,  Fig.  20,  the  pieces  of  solder  ma}'  be  kept 
from  flying  oft'  by  gently  holding  it  in  position  between  the 
pieces  to  be  united.  But  where  the  ends  of  small  tubes  are  to 
be  secured  as  in  C  and  D,  it  is  best  to  first  fuse  the  solder  upon 
the  band,  and  then  hold  the  small  tubes  by  means  of  the  solder- 
ing pliers  in  contact  with  the  solder  and  again  apply  heat^ 
otherwise  the  solder  will  be  drawn  into  the  tube.  The  solder 
best  adapted  in  uniting  the  dififerent  parts  of  these  appliances  is 
the  ordinary  jeweler's  silver  solder,  although  eighteen  carat 
gold  solder  may  be  used.     Plenty  of  borax  should  always  be- 


Fig.  10. 


used  as  a  flux.  Scrape  bright  the  silver  solder  and  the  points 
to  be  soldered,  and  borax  both.  ISTever  use  more  solder  than  is 
necessary,  especially  in  attaching  the  small  tubes;  use  just 
sufl&cient  to  make  the  union. 

Always  avoid  overheating;  just  enough  heat  from  a  small 
flame  to  thoroughly  fuse  the  solder  is  all  that  should  ever  be 
employed.  In  every  instance  avoid  heating  the  screws  or 
nuts.  This  is  to  be  especially  observed  with  the  jack  and  trac- 
tion-screws, as  great  care  is  observed  in  their  manufacture  to 
produce  the  greatest  stiffness  and  strength,  and  this  fine  temper 
is  ruined  by  heating.  The  wire  arches  B  and  E  are  also  manu- 
factured in  such  a  way  as  to  give  to  them  the  greatest  possible 
spring,  second  only  to  steel.  They  must  not  be  heated,  or  this 
delicate  temper  will  be  destroyed. 

The  three  delicate  sheaths  found  on  the  wire  arch  B,  Set  'No.  2, 


MODELS.  23 

are  attached  by  means  of  soft  solder.  Should  one  of  them  be- 
come loosened  it  may  be  resoldered,  using  the  soft  solder  and  a 
drop  of  muriatic  acid,  and  applying  a  fine  flame,  carrying  the 
heat  to  only  Just  the  point  suflicient  to  fuse  the  solder. 


Where  two  or  more  bands  are  to  be  united  in  order  to  retain 
the  teeth  as  in  Fig.  54,  they  should  be  gently  held  by  their  un- 
trimmed  ends  while  being  soldered,  as  in  Fig.  11,  after  which 
they  are  trimmed  with  the  shears. 


CHAPTER    V. 

MODELS. 

In  deciding  upon  a  proper  course  of  treatment  in  any  giyen 
case,  much  care  and  judgment  should  be  exercised,  making  a 
careful  study  of  the  features  and  giving  due  consideration  to 
the  probable  modifying  effects  of  the  proposed  changes,  the 
establishment  of  correct  occlusion,  etc. 

It  is  of  the  first  importance  to  obtain  yery  accurate  articulat- 
ing models  of  both  jaws.  Such  models  not  only  assist  in  form- 
ing a  basis  for  correctly  establishing  the  proper  line  of  opei-a- 
tion,  but  are  exceedingly  valuable  as  references  during  the 
whole  course  of  treatment,  for,  from  such  models,  accurate 
measurements  may  be  taken  from  time  to  time,  and  compari- 
sons be  made  as  the  case  progresses.  In  this  way  one  may  not 
only  judge  of  the  exact  speed  of  the  moving  teeth,  but  unfavor- 
able movements  of  the  anchor-teeth  mav  be  detected. 


24 


THE    ANGLE    SYSTEM. 


In  order  that  these  models  may  be  of  any  value,  they  must 
not  only  accurately  show  the  relative  positions  of  the  teeth  and 
-cusps,  but  they  must  also  indicate  the  rugse,  gums,  and  as  much 
of  the  roots  and  positions  of  the  same  as  indicated  by  the  gums 
and  alveoli,  up  to  the  point  where  the  attachments  of  the 
muscles  render  obscure  the  further  shape  of  the  jaw. 

From  the  large  number  of  imperfect  models  which  I  receive 
each  year  from  dentists,  I  am  of  the  opinion  that  the  value  of 
correct  models  is  not  sufficiently  appreciated. 

Of  the  two  most  important  impression  materials,  plaster  or 
modelling  compound,  I  always  prefer  the  former  on  account  of 

Fig.  12. 


Author's  Impressiox-Trats. 


its  much  greater  accuracy,  although  some  practitioners  use  the 
latter,  claiming  that  it  is  easier  and  neater.  But  with  properly 
shaped  impression-trays,  designed  especially  for  use  in  obtain- 
ing impressions  in  cases  of  irregularities,  as  shown  in  Fig.  12, 
the  operation  is  simple  and  accuracy  certain,  as  the  trays  are  of 
such  shape  and  height  that  it  is  only  necessary  to  evenly  fill 
them  with  plaster,  leaving  but  very  little  surplus  material  to 
cause  annoyance.  The  plaster  should  be  allowed  to  set  hard, 
for  the  more  thoroughly  it  is  allowed  to  harden  the  more  reli- 
able will  be  the  impression.  The  tray  is  then  loosened  from  the 
impression  (it  having  previously  been  slightly  coated  with  oil), 
leavino;  the  impression  still  in   the   mouth.     Two  grooves  are 


MODELS. 


25 


then  scraped  or  cut  in  the  hardened  plaster  on  a  line  parallel 
with  the  cuspid  teeth,  never,  however,  cutting  quite  through. 
Then  \^■ith  a  quick  pry  with  the  point  of  a  penknife  the  an- 
terior plate  is  wrenched  loose.  The  lateral  pieces  are  then 
broken  off  between  the  thumb  and  finger,  when  the  large  piece 
covering  the  roof  of  the  mouth  alone  will  remain.  This  may 
be  readily  worked  loose,  and  if  the  operation  has  been  carefully 
performed,  the  impression  will  then  consist  of  four  pieces 
(although  a  greater  number  will  in  no  ways  injure  it).  The 
pieces  are  readily  reunited  and  held  with  wax  or  by  replacing 
in  the  impression-trays,  and  should  present  the  appearance  illus- 
trated in  Fig.  13. 

Fig.  13. 


\ 


^ 


This  method  preserves  the  fine  points  of  the  interdental 
spaces  from  being  impaired.  I  believe  it  to  be  the  only  prac- 
ticable way  of  taking  an  accurate  impression. 

Not  longer  than  one-half  hour  after  the  impression  has  been 
taken,  the  inside  should  be  thoroughly  coated  with  shellac  var- 
nish ;  at  the  expiration  of  another  half-hour  it  is  again  coated 
with  sandarac  varnish,  and  at  the  end  of  still  another  half-hour 
it  should  be  very  carefully  filled  with  plaster  and  turned  upside 
down  on  a  glass  slab. 

After  the  plaster  has  thoroughly  set,  the  pieces  of  the  impres- 
sion may  usually  be  very  readily  separated  in  the  same  order  in 
which  they  were  removed  from  the  mouth. 


26  THE    ANGLE    SYSTEM. 

The  model  may  now  be  trimmed,  and  not  only  will  there  be 
a  surface  as  smooth  as  polished  marble,  but  each  cusp,  and  all 
the  interdental  spaces,  as  well  as  the  rugse,  and  even  the  minute 
"  stipples"  of  the  gum,  will  be  accurately  and  beautifully  shown. 
The  models  should  now  be  neatly  labeled  to  serve  for  study  and 
reference,  and,  on  occasion,  be  valuable  as  legal  evidence. 

As  soon  as  the  teeth  have  been  completely  moved,  take 
another  impression  and  make  models.  This  should  be  done 
after  all  appliances  have  been  removed,  the  teeth  thoroughly 
cleansed,  and  immediately  previous  to  adjusting  the  retaining 
appliances.  These  models  are  valuable  for  comparison  with  the 
natural  teeth  during  the  period  of  retention,  as  well  as  for 
future  reference.  It  is  also  of  advantage  to  have  "  study 
models"  occasionally  made  during  treatment  and  retention,  by 
pressing  a  piece  of  softened  wax,  about  three-eighths  of  an  inch 
deep,  onto  the  cutting-surfaces  of  the  teeth,  to  accurately  show 
the  positions  of  the  teeth  only,  together  with  such  appliances  as- 
may  be  upon  them. 


CHAPTER    VI. 

DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 

In  the  correction  of  dental  irregularities,  an  appliance  must 
act  either  by  pulling,  pushing,  or  twisting  a  tooth  into  proper 
position;  and  the  movements  of  the  tooth  are  limited  to  six  : 
backward  or  forward  in  the  line  of  the  arch,  outward  or  inward, 
in  the  line  of  the  arch,  elongation  or  depression  of  the  tooth  in 
its  socket. 

Section  I.     Backward  in  the  Line  of  the  Arch. 

The  backward  movement  of  the  teeth  in  the  line  of  the  arch 
is  accomplished  in  two  principal  ways.  First,  by  the  large  trac- 
tion-screw A  and  D,  Set  No.  1,  shown  in  Fig.  14,  for  the  retrac- 
tion of  a  superior  cuspid.  The  first  molar  is  encircled  by  a  ITo. 
2  clamp-band  (Fig.  6),  to  which  is  soldered  the  long  sheath  of  the 
traction-screw  A,  Fig.  1.  The  cuspid  is  also  encircled  by  a 
band,  having  the  short  tube  D,  Set  ISTo.  1,  soldered  horizontally 
to  it  on  its  distal  surface,  with  which  tube  the  smooth  bent  end 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


27' 


of  the  traction-screw  engages.  The  nut,  operating  against  the 
distal  end  of  the  tube,  will  move  the  cuspid  backward  into  po- 
sition.- The  easiest  way  to  adjust  this  appliance  is  to  first  ce- 
ment the  band  upon  the  cuspid;  after  the  cement  has  become 


Retraction  of  Cuspid. 


thoroughly  set,  the  angle  of  the  traction-screw  is  hooked  into- 
the  short  tube,  and  the  adjustable  band  latched  over  the  molar. 
It  is  very  important  that  the  bent  end  be  passed  into  the  tube  its 
full  length,  otherwise  it  will  be  broken  when  force  is  exerted. 
The  screw  may  be  employed  on  the  outside  of  the  arch ;  the 


Fig.  15. 


short  tube,  in  that  event,  should  be  attached  to  the  mesio-buccal 
angle  of  the  band,  as  shown  on  the  right  cuspid  of  Fig.  15. 

If  a  movement  of  rotation  as  well  as  retraction  is  desirable, 
the  angle  of  the  screw  should  be  hooked  over  a  spur,  as  shown 


28  THE    ANGLE    SYSTEM. 

on  the  left  cuspid  of  Fig.  15,  thus  concentrating  all  the  force  upon 
one  side  of  the  moving  tooth.  Recent  experience  has  shown 
that  a  staple  made  from  the  wire  G,  Set  JSTo.  1,  is  stronger  and 
better  than  the  spur  for  making  this  attachment.  Should  the 
cuspid  be  very  prominent,  requiring  the  movement  to  be  inward 
as  well  as  backward,  that  may  be  accomplished  at  the  same 
time  by  bending  the  screw,  which,  as  the  nut  is  turned,  will  be 
gradually  straightened.     (See  Fig.  16.) 

Fig.  16. 


*\ 


A  method  of  reinforcing  the  anchor-tooth  is  also  show^n  in 
this  engraving,  by  enlisting  the  resistance  of  the  lateral  incisor. 
This  tooth  is  banded  and  provided  with  one  of  the  pipes  R,  Set 
N'o.  1,  soldered  to  its  distal  angle ;  one  end  of  a  piece  of  the 
wire  G,  Set  ISTo.  1,  is  soldered  to  the  sheath  of  the  traction- 
screw,  and  made  to  rest  in  this  pipe. 

In  making  the  attachments  for  retraction  after  the  manner 

Fig.  17. 


Stationary  Anchorage. 


described,  it  is  of  the  utmost  importance  that  the  band  encir- 
cling the  molars  should  be  tightly  clamped,  burnished,  and 
firmly  cemented,  so  that  the  attachment  will  be  perfectly  rigid. 
In  this  way  the  resistance  of  the  anchorage  will  be  greatly 
increased,  and  tipping  of  the  anchor-teeth  will  be  prevented ; 
while  if  moved  at  all,  they  must  be  dragged  bodily  through  the 
alveolus,  because  the  apices  of  the  roots  move  equally  with  the 
crown,  as  shown  in  Fig.  17,  which  represents  a  side  view  of  the 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVExMENT. 


29 


Fig.  18. 


appliance  in  position,  the  dotted  lines  showing  the  movements 
which  must  take  place  if  the  attachment  is  properly  made. 
This  is  a  most  perfect  form  of  anchorage,  and  I  am  indebted  to 
Dr.  W.  C.  Barrett  for  first  suggesting  it. 

If  the  nut  is  placed  upon  the  screw  in  front  of  the  sheath  and 
tightened,  force  with  the  same  resistance  of  anchorage  may  be 
exerted  in  moving  the  tooth  for- 
ward instead  of  backward.  AVhen 
the  jack-screw  is  employed  for 
pushing,  the  same  firmness  of  an- 
chorage may  be  gained  by  solder- 
ing the  base  of  the  sheath  to  the 
anchor-band,  which  is  to  be  firmly 
clamped  and  cemented  in  position 
upon  the  anchor-tooth,  as  shown  in 
Fig.  18. 

Another  way  of  moving  teeth 
backward  in  the  line  of  the  arch  is  b}^  means  of  Set  'No.  2, 
and  will  be  described  in  the  treatment  of  cases  of  excessive 
protrusion  of  the  superior  incisors. 

Section  II.     Forward. 
The  movement  of  a  tooth  forward  in  the  line  of  the  arch  may 
be  accomplished  by  means   of  the  traction-screw,  in  the  same 
way  as  already  described  for  retraction,  by  selecting  anchor- 
teeth  on  the  opposite  side  to  be  used  in  overcoming  the  resist- 

Fio.  19. 


ance  of  the  tooth  that  is  being  moved,  as  shown  in  Fig.  19, 
which  represents  a  case  in  practice,  and  shows  the  screw  employed 
in  pulling  both  incisors  forward  in  the  line  of  the  arch  to  close 
the  wide  space  between  the  centrals ;  at  the  same  time  providing 


30 


THE    ANGLE    SYSTEM. 


space  for  the  cuspid,  which  is  being  moved  out  of  inlock  by 
means  of  the  jack-screw.  In  this  case  the  traction-screw  was 
beaten  flat,polished,  and  bent  to  conform  to  the  curve  of  the  arch. 

Section  III.     Outward. 
The  movement  of  a  tooth  from  within  outward  into  the  line 
of  the  arch  is  accomplished  in  four  principal  ways :  first,  by  means 
of  the  jack-screw  E  and  J,  Set  No.  1,  the  sheath  of  which  is 


Fig.  20. 


B 


^secured  to  a  suitable  anchor-tooth,  the  point  acting  upon  the 
moving  tooth  bv  turnino;  the  nut.  The  base  of  the  sheath  of 
the  jack-screw  may  be  secured  in  various  ways,  as  shown  in 
Fig.  20.  First  by  a  dowel  made  by  soft-soldering  a  piece  of  the 
Avire  Or,  Set  No.  1,  into  the  end  of  the  sheath  which  rests  in  a  pit 
in  the  anchor-tooth,  as  in  A.    By  a  spur  made  from  the  same  wire 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


31 


soldered  to  the  anclior-band,  over  which  the  end  of  the  sheath 
is  slipped,  as  in  B.  By  a  dowel  made  from  the  same  wire, 
slipped  into  one  of  the  pipes  E,  Set  ISTo.  1,  soldered  to  the  anchor- 
band,  as  in  C.  (In  this  way  the  length  of  the  sheath  may  also 
be  increased.)  By  pointing  the  end  of  the  sheath  with  a  file 
and  letting  the  point  rest  in  the  pipe  on  the  anchor-band,  as  in 
D.  By  soldering  the  sheath  directly  to  the  anchor-band,  as  in 
E  and  F.  By  notching  the  end  of  the  sheath,  which  shall 
engage  the  anchor-wire  as  in  G,  Fig.  20,  and  Fig.  41.  By  solder- 
ing the  end  of  the  sheath  directly  to  another  sheath,  as  in  H, 
By  means  of  a  spur  made  from  the  wire  G,  Set  l^o.  1,  soldered  to 


the  sheath  which  shall  engage  one  of  the  pipes  R,  Set  I^o.  1,  sol- 
dered to  the  anchor-band,  as  in  I.  By  slipping  the  end  of  the 
sheath  over  the  screw  upon  the  clamp-band,  as  in  J.  Of  these 
various  ways  I  prefer  that  of  attaching  the  sheath  directly  to 
the  anchor-band,  as  in  E  and  F,  or  by  means  of  the  spur,  as  in 
B  (the  spur  being  quickly  and  easily  made  by  soldering),  by 
holding  a  long  piece  of  the  wire  G,  Set  No.  1,  between  two  of  the 
fingers  of  one  hand,  while  the  end  of  the  screw  upon  the  clamp- 
band  is  grasped  between  the  thumb  and  finger  of  the  other 
hand,  carrying  it  in  contact  with  the  fine  point  of  the  flame  (as 
in  Figs.  9  and  10),  presenting  the  appearance  after  soldering 
shown  in  K,  Fig.  20;  after  which  the  wire  is  cut  oif,  leaving  the 
desired  length  of  the  spur.  The  point  of  the  screw  is  held 
firmly  in  position  bj'  six  principal  ways,  as  shown  in  Fig.  21. 


32 


THE    ANGLE    SYSTEM. 


First:  By  notcliing  the  point  of  the  screw  with  a  separating- 
file,  which  notch  will  engage  a  similar  notch  in  the  united  ends 
of  the  band,  as  in  A.  By  pointing  the  end  of  the  screw  to 
engage  one  of  the  small  pipes  R,  Set  'No.  1,  soldered  to  the 
band  as  in  B.  By  a  mortise  in  the  band  to  engage  the 
point  of  the  screw,  as  in  C.  By  soldering  an  elliptical  ring 
(formed  by  bending  the  wire  G,  Set  ISTo.  1,  as  at  G,  Fig.  21),  in 
which  to  rest  the  point  of  the  screw,  as  in  D.  By  a  staple, 
made  from  the  same  wire,  soldered  (see  H)  to  the  band,  as  in 
E,  the  point  of  the  screw  being  suitably  notched.  By  pointing 
the  screw  to  be  received  in  the  pit  formed  in  the  enamel  or 
filling,  as  in  F.  Of  these  various  ways  of  securing  the  point  of 
a  jack-screw,  I  prefer  the  plan  shown  in  D  and  E,  forming  the 
ring  and  staple  upon  the  ends  of  long  pieces  of  the  wire,  which 

Fig.  22. 


serve  as  handles  while  soldering,  as  in  G  and  H,  after  which 
the  superfluous  portions  are  clipped  off.  The  roughened  ends 
are  then  rounded  and  made  smooth  with  a  fine  file. 

Fig.  22  shows  an  in  locked  cuspid  being  moved  outward,  the 
point  of  the  screw  resting  in  a  mortise  formed  in  the  band  upon 
the  moving  tooth,  the  base  of  the  sheath  being  notched  to  engage 
a  piece  of  the  anchor- wire  G,  Set  No.  1,  passing  through  a  tube 
soldered  to  the  lingual  surface  of  the  left  cuspid.  The  anchor- 
age is  greatly  reinforced  by  means  of  this  wire,  which  is  beaten 
flat  where  it  passes  between  the  central  and  lateral,  the  end  be- 
ins:  bent  around  the  labial  surface  of  the  central.  Force  is  ob- 
tained  by  turning  the  nut.  After  a  tooth  has  been  moved  into 
the  desired  position,  it  is  retained  by  a  piece  of  the  wire  G,  Set 
No.  1,  passed  through  a  pipe  R,  Set  No.  1,  soldered  to  the  band, 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT.  33 

tlie  wire  ends  resting  upon  the  labial  surfaces  of  the  lateral 
incisor  and  first  bicuspid.  This  wire  is  held  in  place  by  a  very 
delicate  pin  passing  through  the  pipe  and  one  side  of  the  wire, 
as  in  Fig.  23. 

Fig.  24  shows  a  favorite  method  of  rein-  Fig.  23. 

forcing   the    anchorage.     In    this    case   the 
sheath  of  the  jack-screw  was  placed  on   a    ^^b^w;;  - 
spur  soldered  to  a  bicuspid  clamp-band,  as 
at  B,  Fig.  20.     The  point  of  the  screw  was 
sharpened  and  rested  in  a  pit  formed  in  the 
enamel.    Reinforcement  was  gained  by  hook- 
ing a  piece  of  the  wire  G,  Set  'No.  1,  into  two  pipes  (R,  Set  Ko. 
1),  one  soldered  to  the  sheath  of  the  jack-screw  near  its  base, 
the  other  soldered  to  the  lingual  surface  of  a  lateral  incisor 
band.     If  the  appliance  has  been  carefully  adjusted  the  patient 
may  be  provided  with  a  wrench,  and  instructed  in  turning  the 
nuts  at  proper  intervals. 

Fig.  24. 


(■ 


Recent  experience  has  proven  that  an  easier  way  of  attaching 
the  reinforcement  wire  is  to  omit  the  pipe  attached  to  the  band 
on  the  lateral,  soldering  the  straight  end  of  the  wire  directly  to 
the  band.  The  other  end  of  the  wire  should  be  passed  through 
the  pipe,  on  the  sheath,  and  secured  by  bending  the  end  around 
the  pipe  end. 

Fig.  25  shows  a  left  lateral  being  moved  outward,  reinforoe- 
ment  having  been  gained  in  the  manner  already  described,  using 
two  pieces  of  wire  attached  to  bands  on  the  central  and  cuspid, 
Not  only  was  the  anchorage  reinforced,  but  the  incisor  and 
cuspid  were  prevented  from  being  pushed  out,  the  moving  tooth 
providing  space  for  itself  by  forcing  the  adjoining  teeth  laterally. 

3 


34 


THE    ANGLE    SYSTEM. 


By  this  means  the  most  perfect  form 
employing,  preferably,  the  method  of 
ment  wires  described  in  the  last  case. 

The  second  mode  of  moving  a  tooth 
shown  in  Fig.  25,  where  a  right  lateral 
by  means  of  the  small  traction-screws 
strip  of  the  band-material  (F,  Set  No. 
lateral,  the  ends  resting  upon  the  labial 

Pig.  25. 


of  anchorage  is  secured, 
attaching  the  reinforce- 

from  within  outwards  is 
is  being  forced  outward 
B  and  C,  Set  No.  1.  A 
1)  is  looped  around  the 
surfaces  of  the  adjoining 


teeth.  On  one  end  is  soldered  a  short  tube,  C  (accompanying 
the  screw),  attached  vertically,  while  on  the  other  end  a  similar 
tube  is  attached  horizontally.  Into  these  tubes  the  traction- 
screw  B,  Set  No.  l,is  placed,  being  bent  to  conform  to  the  circle 
of  the  arch,  and  used,  in  this  case,  to  push  instead  of  pull. 
This  appliance  should  be  frequently  tightened  by  turning  the  nut, 
or  it  will  become  loose  and  cause  trouble.  The  parts  of  this 
device  are  shown  separatel_y  in  Fig.  26. 


Pig.  26. 


Pig.  27. 


y 


f.^ 


Fig.  27  shows  the  teeth  as  retained  by  means  of  pieces  of  the 
anchor-wire  (G,  Set  No.  1)  passing  through  pipes  attached  to 
the  labial  surfaces  of  the  bands,  as  described  and  shown  in  Fig.  23. 

The  third  method  of  moving  a  tooth  from  within  outward  is 
by  lacing  the  teeth  to  the  expansion  arch,  as  in  Fig.  28,  force 
being  derived  from  the  spring  of  the  arch  and  sustained  by 
occasionally  turning  the  nuts.     (See  also  Fig.  68.) 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


35 


The  fourth  method  is  by  means  of  th«  wire  ligature  encircling 
the  tooth  and  arch,  force  being  exerted  by  occasionally  twisting 
the  wire,  as  in  A,  A,  Fis;.  28. 


Fig.  28. 


Section  IV.     Inward. 

A  tooth  may  be  moved  inward  by  the  small  traction-screw 
B  and  C,  Set  No.  1,  as  shown  in  Fig.  29,  in  which  a  cuspid  is 
being  drawn  into  line,  the  bent  end  of  the  screw  being  hooked 
into  the  small  tube  C,  Set  No.  1,  soldered  to  the, band  upon  the 
anchor-tooth.  The  other  end  of  the  screw  passes  through  a 
similar  tube,  against  the  end  of  which  the  nut  works.  To  the 
tube  is  soldered  a  piece  of  the  wire  G,  Set  No.  1,  bent  at  right 

Fig.  29. 

.;<SS!p!i^...... 


angles  and  hooked  into  a  pipe  (R,  Set  No.  1),  soldered  to  the 
lingual  surface  of  the  band  on  the  cuspid.  Force  is  exerted  by 
turning  the  nut.  The  anchor-tooth  was  reinforced  by  a  piece  of 
the  wire  G,  Set  No.  1,  resting  in  contact  with  the  buccal  surfaces 
of  the  adjoining  teeth,  and  held  in  position  by  one  of  the  small 


36  THE    ANGLE    SYSTEM. 

pipes  K,  Set  No.  1.  This  anchor-wire  was  kept  from  turning- 
by  a  very  delicate  pin  passing  through  the  pipe  and  one  side  of 
the  wire,  as  in  Fig.  23.  Another  way  of  securing  this  wire  is 
by  soldering  it  directly  to  the  hand. 

Prominent  teeth  ma}'  also  be  forced  into  the  line  of  the  arch 
by  means  of  the  wire  arch  B,  Set  No.  2,  or  the  expansion-arch 
E,  Fig.  4,  made  to  encircle  the  dental  arch  and  bear  against  the 
prominent  tooth,  and  the  force  may  be  intensified  by  an  inter- 
vening wedge  of  rubber.  The  adjoining  teeth  are  firmly  laced 
to  the  arch  by  mieans  of  wire  ligatures,  as  described  in  the  treat- 
ment of  the  case  shown  in  Fig.  65. 

Section  Y.     Rotation. 

There  are  three  principal  modes  of  rotation  by  this  system. 
First :  by  means  of  the  lever,  band,  and  tube,  as  shown  in  Fig. 
30,  which  represents  a  lateral  incisor  in  process  of  rotation.  The 
incisor  was  cemented  in  position  with  an  accurately-fitting  band 

-^      „„  bavin o;  soldered  to  it  one  of  the  small 

Fig.  30.  '='  .  , 

pipes  R,  Set  No.  l,into  which  is  inserted 
the  end  of  one  of  the  levers  L,  Set  No. 
1,  the  other  end  being  sprung  around 
and  secured  to  a  suitable  anchor-tooth. 
This  attachment  of  the  end  of  the  lever 
may  be  made  in  various  ways, — either 
by  being  latched  into  a:  notch  formed  in 
the  united  ends  of  the  band  as  shown 
in  Fig.  30,  or  by  a  wire  ligature  made 
to  encircle  the  anchor-tooth  and  lever, 
or  by  a  wire  ligature  encircling  the 
button  on  the  clamp-band  (No.  3  or  4,  Fig.  6),  and  attached  to 
the  end  of  the  lever  bent  in  the  form  of  an  eye ;  which  is  now  my 
favorite  method.  The  anchor-tooth  may  be  reinforced  by  a  piece 
of  the  wire  G,  Set  No.  1,  resting  in  contact  with  the  lingual 
surface  of  the  adjoining  teeth,  and  held,  in  position  by  one  of 
the  pipes  R,  Set  No.  1,  soldered  to  the  anchor-band  as  shown. 
It  will  be  seen  that  thus  a  constant,  powerful,  rotative  force  may 
be  exerted  upon  the  tooth. 

Care  should  be  exercised  that  the  lever  be  not  allowed  to  pry 
against  the  intervening  teeth,  to  force  the  tooth  outward. 

It  is  often  desirable  to  lace  one  or  more  of  the  intervening- 
teeth  to  the  lever  by  means  of  the  wire  ligature,  to  prevent  over- 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


37 


Fig.   31. 


lapping  of  the  teeth.  The  leverage  may  be  increased  by  allow- 
ing the  end  to  pass  through  the  pipe,  and  to  bear  against  the 
labial  surface  of  the  adjoining  tooth.  This  may  be  intensified 
by  an  intervening  wedge  of  rubber. 

Fig.  31  shows  the  rotated  incisor  retained  by  a 
short  piece  of  the  wire  G,  Set  No.  1,  slipped  into 
the  pipe  from  the  opposite  side  and  made  to  bear 
asainst  the  labial  surface  of  the  central  incisor. 
There  should  also  be  soldered  a  spur  to  the  disto- 
lingual  angle  of  the  band  and  made  to  bear 
against  the  cuspid. 

Fig.  32  shows  two  cuspids  being  rotated   by  this   method. 

Fig.  32. 


Retainer. 


It  will  also  be  seen  that  the  lever  may  be  employed  on  the 
inside  of  the  arch,  and  in  this  case  there  was  the  advantage  of 
reciprocal  anchorage  resulting  from  the  ends  of  the 
levers  acting  in  opposite  directions  upon  the  anchor- 
tooth. 

In  all  similar  cases  where  the  lever  is  being  em- 
ployed on  the  outside  of  the  arch  it  should  be  bent 
at  the  point  nearest  the  labial  surface  of  the  cuspid, 
so  as  to  concentrate  all  the  spring  in  the  region 
of  the  moving  tooth. 

Second:  Rotation  ma}'  also  be  performed,  as 
shown  in  Fig.  33,  by  means  of  the  jack-screw  E  and 
J,  Set  E"©.  1,  secured  by  staple,  clamp-band  and 
spur,  and  pushing  against  one  side  of  the  tooth  to 
be  moved,  while  the  small  traction-screw,  attached 
by  pipe  R,  Set  No.  1,  and  piece  of  anchor-wire  G, 
Set  No.  1,  soldered  to  the  base  of  the  sheath  of  the  jack-screw, 


38  THE    ANGLE    SYSTEM. 

is  made  to  pull  upon  the  other  side  of  the  tooth.  In  this  way- 
perfect  control  of  the  tooth  is  gained,  not  only  in  rotation  but  also 
in  pushing  it  outward  or  pulling  it  inward  into  the  line  of  the 
arch,  according  as  the  nuts  are  adjusted.  This  method  of 
rotation  is  principally  limited  to  the  superior  central  incisors  or 
cuspids.  It  should  be  said  that  because  of  the  powerful  force 
they  exert  the  nuts  should  be  turned  but  slightly  at  each  sitting. 
This  is  also  another  instance  where  use  is  made  of  reciprocal 
anchorage,  which  is  to  be  taken  advantage  of  whenever  possible. 
Third :  Rotation  may  be  accomplished  by  exerting  force  on 
one  side  of  a  tooth  by  means  of  a  wire  ligature  on  the  expan- 
sion-arch E,  and  a  spur  soldered  to  a  band  encircling  the  tooth 
to  be  moved,  as  at  B,  Fig.  28.  This  force  may  be  intensified  by 
a  wedge  of  rubber  stretched  between  the  band  and  arch  and  act- 
ing upon  the  opposite  side  of  the  tooth,  as  in  Fig.  68.  A  modifica- 
tion of  this  plan  of  rotation  is  shown  at  C,  Fig.  28,  in  which 
the  band  is  dispensed  with  and  the  double  or  loop  ligature  is 
continued  around  the  tooth,  including  the  wire  arch.  This 
plan  is  less  certain  on  account  of  the  liability  to  slip :  it  is 
also  less  powerful,  since  the  wedge  of  rubber  cannot  be  used. 
It,  however,  will  be  found  useful  where  teeth  are  to  be  but 
slightly  rotated.  At  the  same  time  a  number  of  other  teeth 
should  be  ligatured  to  the  arch  to  secure  greater  firmness. 

Section  VI.     Double  Rotation. 

"When  two  teeth  are  to  be  rotated  in  opposite  directions  at 
the  same  time,  as  the  central  incisors  shown  in  Fig.  34,  double 

Fig.   34.  Fig.  35. 


Double  Rotation. 

rotation  may  be  accomplished  by  a  single  lever.  In  this  instance 
both  the  teeth  are  banded,  and  a  tube  soldered  to  each  band. 
A  straight  lever  is  inserted  in  one  tube,  springing  and  sliding  it 
into  the  other  tube  in  the  same  manner  in  which  a  door-bolt  is 
slid  into  position,  as  also  shown  in  Fig.  35.  It  maybe  necessary 
to  occasionally  remove  and  straighten  the  lever  a  little,  in  order 
to  maintain  the  pressure.     Should  one  tooth  be  rotated  suffici- 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT.  39 

ently  before  the  other,  further  movement  may  be  arrested  by 
removing  the  band  and  soldering  a  lug  on  the  lingual  surface 
to  rest  against  the  lateral  incisor.  And  should  the  teeth  in  rota- 
tion assume  too  much  prominence,  by  reason  of  pressure  from 
the  adjoining  teeth,  it  may  be  effectually  corrected  by  requiring 
the  patient  to  wear,  for  a  few  nights,  the  head-gear,  traction- 
bar,  and  heavy  elastic  bands  shown  in  Figs.  2  and  3,  filing  a 
deep  notch  in  the  end  of  the  standard  to  engage  the  rotating 
lever. 

If  the  teeth  show  a  tendency  to  separate  as  they  rotate,  they 
should  be  drawn  tightly  together  by  a  ligature,  made  to  encircle 
both  tubes  and  held  in  position  by  the  ends  of  the  lever,  slightly 
protruding  through  the  tubes. 

When  the  teeth  are  in  position  they  are  retained  by  substi- 
tuting a  piece  of  the  non-elastic  wire  G,  Set  No.  l,for  the  spring 
wire,  or  better  still,  by  uniting  the  bands  with  solder  and  re- 
cementing  them,  as  first  suggested  by  Professor  Guilford,  and 
shown  in  Figs.  11  and  89. 

Of  the  levers  shown  at  L,  Set  No.  1,  four  different  sizes  are 
furnished.  The  smallest  size  is  quite  strong  enough,  in  most  in- 
stances, for  double  rotation,  and  is  most  commonly  used  by  me, 
especially  on  the  teeth  of  children. 

These  levers  are  plated  in  such  a  manner  as  to  nearly  over- 
come the  annoyance  of  oxidation  and  discoloration  of  the  teeth 
in  their  use,  thus  obviating  an  objection  to  the  employment  of 
steel  wire  in  the  construction  of  regulating  appliances. 

The  reader  should  never  confuse  the  -vvire  G,  Set  No.  1,  with 
these  levers.  Their  uses  are  as  different  as  the  material  of  which 
they  are  composed.  The  levers  are  used  only  in  rotation  (occa- 
sionally in  expansion),  and  are  never  united  by  solder  in  form- 
ing an  attachment;  while  the  wire  G,  Set  No.  1,  is  extremely 
tough  and  malleable  and  has  a  very  wide  range  of  application, 
such  as  reinforcing  anchorage,  retention,  making  spurs,  staples, 
etc. 

Section  YII.     Elevation. 

The  elevation  of  a  tooth  in  its  socket  may  be  accomplished  as 
shown  in  Fig.  36,  wherein  a  superior  cuspid  is  being  drawn  out 
or  erupted  into  line.  The  clamp-band  No.  3,  Fig.  6,  was  fixed 
on  the  lower  second  bicuspid.  A  very  small  hole  was  drilled 
into  the  cuspid,  and  a  short  pin  was  set  with  thin  cement.  A 
common  pin  answers  the  purpose  very  well,  and  the  hole  need 


40  THE    ANGLE    SYSTEM. 

not  be  deeper  than  the  enamel  if  the  pin  is  accurately  fitted  to 
it.  A  rubber  ligature  was  given  the  patient  with  instructions 
to  slip  it  over  the  pins,  as  shown  in  the  engraving.  The  anchor- 
tooth  in  this  case  is  directly  opposed  by  the  superior  bicuspid. 
The  anchorage  is  simple  and  efficient.  The  ligature  may  be 
worn  at  night  only,  so  as  to  interfere  as  little  as  possible  with 
speech  and  mastication,  although  some  patients  wear  it  almost 
continuously.     Too  strong  a  ligature  should  not  be  worn,  as  it 

Fig.  SG. 


r 

{ 


might  endanger  the  life  of  the  pulp,  but  gentle  traction  should  be 
used,  gradually  directing  the  tooth  into  its  proper  position. 
The  direction  of  force  to  be  exerted  upon  the  tooth  to  be  moved 
will  of  course  indicate  which  tooth  in  the  inferior  arch. should 
be  selected  for  anchorage.  Should  the  anchorage  fall  upon  a 
tooth  with  no  antagonist  there  would,  of  course,  be  danger  of 
loosening  it. 

Fm.   37. 


Fig.  37  shows  a  case  in  which  the  anchorage  was  modified  to 
suit  the  conditions.  A  deciduous  cuspid  had  been  retained  too 
long,  causing  the  permanent  cuspid  to  remain  in  the  alveolar 
process  on  the  palatal  side  of  the  lateral  incisor,  necessitating  a 
complex  movement  of  the  tooth  backward,  outward,  and  down- 
ward, requiring  a  very  firm  anchorage  and  a  strong  ligature. 
On  the  inferior  cuspid  and  second  bicuspid  were  fixed  bands, 
having  pipes  R,  Set  No.  1,  attached  to  their  labial  surfaces.     A 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


41 


piece  of  the  wire  G  of  suitable  length  was  bent  at  right  angles 
and  hooked  into  the  pipes,  as  shown.  The  wire  fits  the  bore  of 
the  pipe  so  accurately  that  in  cutting  off  the  ends  which  emerge 
through  them,  each  end  spreads  sufficiently  to  prevent  its  com- 
ing out.  A  pin  was  soldered  to  the  wire  about  midway  between 
the  pipes.  The  ligature  was  stretched  from  pin  to  pin,  as  seen 
in  the  engraving. 

Fig.  38  shows  a  modification  of  this  method  of  anchorage. 

Pir;.  38. 


The  anchor-wire  was  made  detachable  and  the  pin  dispensed 
with,  the  patient  slipping'  the  wire  through  the  ligature  and  into 
the  pipes  upon  retiring,  and  removing  it  during  the  day.  A 
delicate  band  (made  of  F,  Set  IS'o.  1),  to  which  was  soldered  the 
pin,  was  fixed  on  the  moving  tooth. 

Fig.  39  illustrates  a  case  in  which  the  appliances  used  were 

Fig    39. 


similar  to  those  before  described,  but  the  wire  anchorage  was 
attached  to  teeth  in  the  same  arch  in  which  was  located  the 
malposed  tooth.  The  first  bicuspid  was  banded  and  a  pipe  R, 
Set  ISTo.  1,  soldered  to  the  labial  surfVice  of  the  band,  in  which  was 
hooked  a  piece  of  the  wire  G,  Set  'No.  1,  the  other  end  of  the 
wire  being  bent  so  as  to  rest  on  the  cutting-edge  of  the  lateral 
incisor.     A  pin  was  soldered  to  this  wire,  as  in  the  case  before 


42  THE    ANGLE    SYSTEM. 

described,  and  a  rubber  ligature  stretched  from  pin  to  pin.  In 
some  cases  where  more  force  was  necessary,  I  have  used  the 
combined  anchorage  described. 

A  tooth  may  be  elevated  in  its  socket  by  employing  either  of 
the  wire  arches  E  or  B  as  an  anchorage;  attaching  the  ligature 
to  the  tooth  to  be  moved  in  any  of  the  ways  already  described. 

Fig.  40. 


Fig.  40  shows  a  case  where  all  of  the  upper  incisors  are  being 
elevated  by  this  method.  Considerable  downward  spring  was 
given  to  the  anterior  part  of  the  arch,  by  spurs  attached  to  bands 
on  the  cuspids,  which  furnish  a  bearing  or  fulcrum  for  the  wire 
arch.  Force  is  exerted  in  this  case  by  the  downward  spring  of 
the  wire  arch  after  it  has  been  attached  to  the  moving  teeth  by 
wire  ligatures  or  bands  with  spurs. 

Section  VIII.     Expansion. 

There  are  several  modes  of  expanding  the  arch  by  this  system. 
First :  By  banding  and  tubing  the  first  and  last  teeth  of  those  to 
be  moved  on  each  side,  and  connecting  them  by  means  of  wire 
(G)  passing  through  the  tubes.  The  jack-screw  is  then  placed 
in  position  across  the  arch,  from  wire  to  wire.  Collars  E>,  Set 
ISTo.  1,  are  soft-soldered  to  the  wire  at  intervals  to  keep  the  screw 
in  proper  position.  The  jack-screw  may  be  moved  forward  or 
backward,  according  to  the  varying  requirements  of  the  case. 
Before  placing  in  position,  the  wires  which  pass  along  the  sides 
of  the  arch  should  be  bent  to  correspond  to  the  shape  of  the 
sides  of  an  ideal  arch,  or  exactly  as  we  wish  the  teeth  to  be 
when  finally  arranged.  The  appliances  in  position  are  accurately 
shown  in  Fig.  41. 

Fig.  42  shows  a  modification  of  this  method  of  expansion, 
the  force  being  derived  from  one  of  the  levers  L,  Set  ISTo.  1,  bent 


DIRECTION    OF    FORGES    FOR    TOOTH-MOVEMENT. 


43 


in  the  form  of  the  well-known  Coffin  spring,  affording  all  the 
advantages  of  the  Coffin  method  of  expansion,  without  the  dis- 
agreeable features  of  the  rubber  plate.  Its  chief  advantage  over 
the  above  method  is  that  it  may  be  also  used  in  expanding  the 


Fig.  41. 


piiaiili 


lower  arch,  without  interfering  with  the  movement  of  the  tongue, 
as  would  jack-sere v\'s. 

The  appliance  for  double  rotation  shown  upon  the  central 
incisors  has  already  been  described,  and  is  repeated  only  to  illus- 


FiG.  42. 


trate  how  it  may  be  used  with  advantage  while  the  arch  is  being 
expanded  laterally;  the  rubber  ligature  is  used  at  the  same  time 
to  retract  the  incisors. 

The  extra  tubes,  soldered  at  right  angles  to  little  collars  slipped 


44  THE    ANGLE    SYSTEM. 

upon  the  bars  on  each  side  of  the  arch,  are  for  engaging  the 
expanding  spring,  should  it  be  found  necessary  to  transfer  the 
pressure  to  that  part  of  the  arch.  Should  it  be  found  necessary 
to  move  a  tooth  beyond  this  side  bar,  stretch  a  rubber  wedge 
between  the  tooth  and  bar,  as  shown  in  Fig.  86.  This  simple 
method  of  moving  a  tooth  beyond  the  limits  of  the  appliance 
will  be  found  valuable  in  connection  with  other  parts  of  this 
system. 

Another  method  of  expanding  the  arch  laterally,  as  well  as 
anteriorly,  is  by  means  of  the  appliances  shown  in  Fig.  43, 
wherein  the  notched  ends  of  the  jack-screw  engage  a  piece  of 
one  of  the  wire  levers  L,  Set  No.  1,  held  in  position  by  notches 
formed  in  the  united  ends  of  the  bands  upon  the  lateral  incisors. 

Fig.  43. 


The  sheaths  of  the  screws  were  held  by  solder  to  anchor  clamp- 
bauds  on  the  first  molars.  The  incisors  were  moved  forward 
by  turning  the  nuts  upon  the  jack-screws,  while  the  arch  was 
being  expanded  laterally,  by  means  of  one  of  the  spring  levers 
L,  Set  N"o.  1,  the  ends  of  which  had  been  bent  sharply  at  right 
angles,  and  made  to  engage  the  delicate  holes  bored  into  the 
sides  of  the  sheaths  of  the  jack-screws,  all  as  clearly  shown  in 
the  engraving.  A  modification  of  this  plan  is  to  exert  pressure 
laterally  by  means  of  a  third  jack-screw  instead  of  the  spring, 
this  screw  being  notched  at  each  end  and  made  to  rest  in  con- 
tact with  the  screws  upon  the  sides  of  the  arch,  anterior  to  their 
nuts. 

Another  excellent  method  of  expanding  the  arch  is  by  means 
of  lacing  the  teeth  to  the  expansion-arch  E,  shown  in  Figs.  4 
and  68.  The  wire  ligatures  are  occasionally  tightened  by  twist- 
ing, until  the  teeth  have  been  moved  outward  and  made  to  con- 
form to  the  shape  of  the  wire  arch.     The  increasing  of  the  arch 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


45 


is  provided  for  by  adjusting  the  nuts  in  front  of  the  tubes  upon 
the  anchor-bands.  By  this  method,  one  or  both  of  the  lateral 
sides  of  the  arch  may  be  expanded,  or  the  anterior  part  of  the 
arch  alone  may  be  moved  forward,  in  which  case  the  teeth  are 
laced  to  the  arch  and  moved  forward  collectively  by  turning  the 
nuts.     (See  Fig.  68.) 

In  expanding  the  lateral  halves  of  the  arch  by  this  method, 
the  wire  arch  should  be  straightened  sufficiently  to  give  all  pos- 
sible spring,  which  in  most  instances  exerts  sufficient  force.  In 
cases  where  the  teeth  are  extremely  firm,  the  expansion-arch 
may  be  reinforced  by  the  spring  from  one  of  the  levers  L,  Set 
No.  1,  bent  to  conform  to  the  inside  of  the  arch,  and  made  to 
press  upon  the  anchor-bands  D.  The  ends  of  the  wire  are  held 
in  position  by  being  bent  at  right  angles,  and  slipped  into  pipes 

Fig.  44. 


R,  Set  xTo.  1,  which  have  been  soldered  at  right  angles  to  tubes, 
C,  slipped  over  the  ends  of  the  screw  upon  the  clamp-bands  D, 
all  as  shown  in  Fig.  44. 

If  it  is  desirable  to  exert  pressure  only  upon  the  bicuspids, 
the  spring  of  L  alone  is  sufficient,  when  held  in  proper  position, 
by  securing  the  ends  in  either  of  the  following  w^ays :  By  rest- 
ing in  one  of  the  pipes  R,  Set  JN"o.  1,  soldered  to  the  clamp-band 
(the  end  of  the  pipe  being  closed  as  shown  on  the  left  of  Fig. 
45),  the  arch  being  bent  so  as  to  lie  in  contact  with  and  also  exert 
pressure  upon  the  first  bicuspid;  or  the  end  maybe  secun-ci, 
as  on  the  right  of  Fig.  45,  by  being  bent  to  engage  one  of  the 
pipes  R,  Set  jSTo.  1,  soldered  to  the  nut  upon  the  clamp-band,  the 
end  of  the  band-screw  resting  against  the  first  bicuspid.  The 
nut  must  be  removed  from  the  screw  wdnle  soldering,  or  piec-ns 
of    the   anchor-wire  G    may  be    soldered    to   the  clamp-bands 


46 


THE    ANGLE    SYSTEM. 


encircling  the  second  bicuspids,  the  front  ends  in  contact  with 
the  lingaal  surfaces  of  the  first  bicuspids.  To  these  wires  are 
soldered  at  right  angles  the  pipes  R,  which  engage  the  ends  of 
the  spring,  as  in  Fig.  46.     Or  the  same  attachment  to  the  clamp- 


FiG.   45. 


bands  upon  the  bicuspids  may  be  made  as  already  described  and 
shown  in  Fig.  44. 

If  it  is  desirable  to  exert  pressure  upon  one  tooth  only,  a  pipe 
should  be  soldered  to  the  band  over  the  tooth  to  be  moved  ;  in 
this  pipe  rests  the  end  of  the  spring.     Bend  the  spring  so  that 

Fig.  46. 


all  the  force  will  be  exerted  upon  the  one  tooth  to  be  moved, 
while  two  or  even  more  teeth  as  anchorage  on  the  opposite  side 
of  the  arch  antagonize  this  force.  This  latter  plan  will  be 
found  useful  in  moving  outward  or  inward  a  single  molar,  which 
is  sometimes  desirable  in  order  to  establish  perfect  occlusion. 


PRACTICAL    CASES.  47 


CHAPTER   VIL 


PRACTICAL    CASES. 


Section  I.  Having  completed  the  description  of  the  principal 
ways  of  constructing  and  adjusting  the  appliances  for  moving 
and  retaining  the  teeth,  although  the  same  methods  would  be 
adopted,  some  practical  cases  are  appended  to  familiarize  the 
reader  with  this  system,  and  enable  him  to  more  easily  compre- 
hend its  intelligent  employment.  Such  simple  cases  as  are  found 
in  early  childhood  will  be  first  cited.  There  is  probably  no  limit 
as  to  the  time  at  which  the  treatment  of  dental  irregularities  may 
be  commenced.  Cases  treated  so  late  as  at  sixty  years  of  age 
have  been  reported;  but  I  am  more  and  more  impressed  with  the 
great  advantages  of  beginning  the  treatment  early,  just  as  soon 
as  the  appearance  of  irregularities  is  manifest  and  the  teeth  have 
emerged  from  the  gum  sufficiently  to  admit  of  banding.  Then, 
when  growth  and  repair  are  most  rapid,  and  the  surroundings 
most  yielding,  employ  simple,  delicate  appliances  to  gradually 
move  the  teeth  into  their  normal  positions.  Studiously  avoid 
needless  interference  in  those  cases  where  it  is  apparent  that  na- 
ture will,  unaided,  correct  the  deformity;  but  take  professional 
pride  in  encounters  with  the  interlocked,  twisted  and  overlapped, 
or  otherwise  malposed  teeth,  which  usually  become  worse  and 
complicate  the  condition  of  the  teeth  yet  to  be  erupted. 

There  is  an  impression  among  a  large  number  of  dentists  that 
treatment  should  be  deferred  until  after  the  age  of  fifteen,  or 
thereabouts,  or  until  the  teeth  have  taken  their  positions  in  the 
arch;  but  this  impression  is  erroneous  and  fruitful  of  much 
harm,  for  by  that  time  cases  become  complex  and  often  exceed- 
ingly difficult  to  treat,  and  conditions  are  established  which  it  is 
impossible  to  wholly  overcome. 

With  proper  appliances  used  at  the  right  time,  a  few  days  will 
often  accomplish  what  might  otherwise  require  many  months 
if  left  until  the  whole  dental  apparatus  is  in  disorder.  The  dis- 
comfort and  annoyance  of  a  suitable  regulating  appliance  is 
slight  in  youth,  but  liable  to  increase  somewhat  with  advancing 
years;  yet  at  no  time  of  life,  if  the  operation  be  skillfully  per- 
formed, need  there  be  more  than  inconvenience;  never  real 
pain. 

Fig.  47  shows  an  erupting  central  iticisor  being  moved  out  of 


48 


THE    ANGLE    SYSTEM. 


inlock.  The  tooth  was  banded  and  one  of  the  pipes  R,  Set  IsTo. 
1,  soldered  to  the  mesio-lingual  angle  of  the  band;  one  end  of 
a  piece  of  the  wire  G,  of  suitable  length,  tvas  inserted  into  this 
pipe,  and  the  other  end  secured  in  a  pit  formed  in  the  enamel 
of  the  second  deciduous  molar.  Force  was  exerted  upon  the 
tooth  to  be  moved  by  occasionally  pinching  this  wire  with  the 
regulating  pliers  H,  Fig.  8  B,  two  or  three  pinches  being 
enough  to  lengthen  the  wire  sufficiently  to  move  the  tooth  as 
far  as  it  should  be  at  one  sitting.  The  force  of  the  wire  being 
exerted  wholly  upon  the  mesio-angle  of  the  tooth,  it  was  rotated 
as  well  as  moved  out  of  inlock.  The  occlusion  of  the  lower 
incisors  retained  it  in  its  new  position. 

Of  course,  one  of  thje  jack-screws,  instead  of  the  wire,  might 
have  been  employed,  but  the  force  exerted  by  stretching  the 

Fig.  47. 


wire  is  so  simple,  and  the  mere  wire  so  compact  and  powerful, 
that  it  is  now  employed,  especially  in  the  treatment  of  children's 
teeth,  whenever  possible. 

Fig.  48  illustrates  a  case  which  I  believe  to  be  so  common 
that  it  may  be  regarded  as  typical,  and  the  method  of  treat- 
ment is  one  which  may  be  generally  employed  in  this  class  of 
cases.  Because  of  lateral  pressure  the  superior  central  incisors 
had  erupted  much  anterior  to  their  natural  positions,  and  the 
laterals  were  appearing  posterior  to  their  correct  positions  (this 
condition  is  not  clearly  shown  in  the  engraving) ;  while  the 
lateral  pressure  from  the  inferior  deciduous  cuspids  caused  the 
central  incisors  to  erupt  inside,  and  the  laterals  outside  of  the 
line.  The  treatment  clearly  indicated  was  to  exert  lateral 
pressure  upon  the  inferior  cuspids,  sufficiently  to  provide  space 


PRACTICAL    CASES. 


49 


for  the  erupting  incisors.  As  the  lower  cuspids  were  gradually- 
forced  farther  apart  their  occlusion  with  the  superior  cuspids 
caused  them  also  to  be  forced  farther  apart,  thereby  providing 
space  for  the  erupting  superior  incisors.  ISTo  attempt  was  made 
to  straighten  the  incoming  teeth  other  than  to  provide  space  for 
their  proper  eruption. 

Fig.  48. 


The  appliance  exerting  lateral  pressure  upon  the  inferior 
cuspids  is  shown  in  Fig.  49.  A  straight  piece  of  the  wire  G, 
Set  Xo.  1,  was  secured  by  springing  the  ends  into  pits  formed 
in  the  enamel  on  the  lingual  surfaces.  Force  was  exerted  by 
occasionally  pinching  with  the  regulating  pliers  to  lengthen  the 
wire  as  already  described.  About  once  a  week  was  as  often  as 
the  wire  was  lengthened. 

Fig.  49. 


Fig.  50  shows  another  case  in  which  a  modification  of  this 
plan  of  treatment  was  used.  I^ot  only  was  it  requisite  to  exert 
lateral  pressure  upon  the  inferior  cuspids  in  order  to  provide 
space  for  the  erupting  permanent  incisors,  but  also  to  apply 
gentle  pressure  to  the  laterals  which  were  erupting  far  inside  of 

4 


50 


THE    ANGLE    SYSTEM. 


the  dental  arcli.  The  cuspids  were  banded  and  pipes  R,  Set 
'No.  1,  attached  to  their  disto-labial  surfaces.  The  distal  ends 
of  the  pipes  were  then  closed  by  a  soldered  piece  of  band 
material.  Into  the  other  ends  of  these  pipes  was  slipped  a 
piece  of  the  wire  G,  bent  to  conform  to  the  curve  of  the  arch. 
Force  was  exerted  by  pinching  the  wire  with  the  regulating 
pliers  H,  Fig.  8  B,  as  before  described.  Gentle  traction  upon 
the  malposed  laterals  was  made  by  encircling  them  and  the  regu- 
lating-wire with  ligatures,  which  were  occasionally  tightened 
by  twisting.  The  occlusion  of  the  cuspids  with  the  superior 
cuspids,  as  in  the  case  last  described,  caused  the  expansion  of 
the  upper  arch.  I  believe  the  line  of  treatment  here  indicated, 
namely:  beginning  at  the  proper  period,  gently  expanding  the 
inferior  arch  and  perfectly  arranging  the  four  incisors,  will 
solve  the  problem  of  treatment  in  a  very  large  percentage  of 


Fig    50. 


cases,  the  upper  teeth  being  forced  to  develop  normally  by  the 
occlusion  with  the  moving  lower  teeth. 

In  pursuing  this  line  of  treatment,  the  expansion  of  the  lower 
arch  must  be  accomplished  very  gradually,  or  an  inlocking  of 
the  upper  teeth  will  be  the  result. 

Fig.  51  shows  the  expansion  of  the  anterior  part  of  the  in- 
ferior arch  by  the  same  method,  the  ends  of  the  wire  being 
soldered  directly  to  the  lingual  surfaces  of  the  bands  encircling 
the  cuspids.  The  patient  was  a  young  lady,  twenty-two  years 
of  age,  and  considerable  force  was  necessary,  but  the  force  ex- 
erted by  pinching  the  wire  was  found  sufficient. 

The  centrals  were  drawn  into  the  line  of  arch  by  means  of 
wire  ligatures,  occasionally  tightened. 

A  little  experience  in  stretching  the  wire  with  the  regulating 
forceps  will  enable  the  operator  to   manipulate  the  wire,  by 


PRACTICAL    CASES. 


51 


bending  as  well  as  pinching,  so  that  rotation  as  well  as  other 
movements  may  be  thus  accomplished. 

Fig.  52  shows  how  an  ordinary  stay-plate  may  by  this 
method  l^e  modified  to  advantage  by  removing  a  portion  of 
it  and  substituting  in  its  place  a  piece  of  the  wire  G,  Set  No.  1, 
bent  and  inserted  in  such  a  way  as  to  bring'pressure  upon  the 


teeth  to  be  moved;  which  pressure  is  occasionally  intensified 
by  pinching  the  wire  with  the  stretcher. 


Fig.  53  represents  the  result  of  an  unnatural  contraction  of 
the  lips,  thus  bringing  undue  pressure  on  the  anterior  part  of 
the  arch  during  the  eruptive  period,  and  forcing  the  teeth 
inward.  They  were  pushed  outward  by  the  jack-screws  rest- 
ing over  spurs  upon  the  anchor-bands,  the  chisel  ends  of  the 
screw  resting  in  stots  formed  in  bands  on  the  moving  teeth. 
(See  B,  Fig.  20,  and  C,  Fig.  21.)  The  teeth  were  also  rotated 
at  the  same  time  with  the  rotating  levers  previously  described, 


52 


THE    ANGLE    SYSTEM, 


and  here  well  shown.  In  this  instance  two  levers  were  used^ 
crossing  each  other  in  the  center.  The  lever  on  the  left  was 
anchored  by  latching  it  into  a  hook  soldered  to  the  anchor-band 
on  the  second  bicuspid.  The  other  lever  was  anchored  by  hook- 
ing it  into  one  of  the  little  pipes  E,  Set  !N"o.  1,  soldered  at  right 
angles  to  the  tube  on  the  band  of  the  lateral  which  engages  the 


Fig 


Other  lever.  A  better  way  would  have  been  to  have  secured 
this  end  of  the  lever  by  a  ligature  around  the  end  of  the  other 
lever,  but  it  is  here  shown  to  illustrate  one  of  the  many  optional 
ways  of  securing  the  end  of  the  lever. 

It  will  be  seen  that  the  central  incisors  also  need  rotating. 
This  could  have  been  easily  accomplished  by  the  double  rotation 


Fig.  .',4 


-A 


lever,  but  the  same  practical  result  was  attained  by  lacing  them 
to  the  levers  with  wire  ligatures.  They  were  retained  by  bands 
united  with  solder.  (See  Fig.  54.)  This  is  an  excellent  method 
of  retention,  and  was  first  suggested  by  Dr.  Guilford.  They 
could  have  been  retained  by  my  own  method,  namely,  by  pass- 
ing a  piece  of  retaining-wire  G  through  the  horizontal  pipes 


PKACTICAL    CASES.  53 

which  had  secured  the  ends  of  the  levers,  and  lacing  the  centrals 
to  it;  but,  although  a  simple  and  effective  device,  it  would  have 
been  a  little  less  sightly. 

Fig.  55  shows  a  form  of  irregularity  frequently  met  with.  The 
arch  is  narrow,  and  the  lateral  incisors  are  being  rapidly  forced 
inward  by  the  erupting  cuspids.  In  a  very  few  months,  without 
treatment,  the  lateral  incisors  would  be  forced  far  inward,  and 
even  the  apices  of  the  roots  would  be  malposed ;  therefore,  the 
earlier  regulation  treatment  is  begun  the  better  for  all  concerned. 

The  proper  treatment  is  the  expansion  of  the  arch  in  the 
region  of  the  bicuspids,  and  the  moving  of  the  centrals  forward 
and  the   laterals   outward.     In   the   case   illustrated   this  was 


accomplished  by  the  jack-screws  engaging  at  their  notched  ends 
a  piece  of  one  of  the  levers  L,  Set  No.  1,  made  to  rest  in  notches 
formed  in  the  united  ends  of  the  bands  encircling  the  lateral 
incisors.  Anchorage  for  the  jack-screws  was  gained  by  solder- 
ing the  sides  of  the  sheaths  to  the  anchbr-clamp  for  the  first 
molars  (as  in  F,  Fig.  20),  while  the  lateral  sides  of  the  arch  were 
forced  outward  by  means  of  a  piece  of  one  of  the  spring  levers 
L,  Set  No.  1,  the  ends  of  which  were  bent  sharply  at  right 
angles  and  made  to  engage  small  holes  drilled  through  the 
sheaths  of  the  jack-screws.  Wire  ligatures  were  made  to  en- 
circle the  central  incisors  and  the  spring  lever  engaged  by  the 
notched  points  of  the  jack-screws.  All  as  clearly  shown  in  the 
engraving.  The  extra  holes  represented  in  the  sheaths  were  for 
shifting  the  expansion  spring,  should  it  be  found  necessary. 

After  the  teeth  had  been  moved  into  their  desired  positions, 
the  bicuspids  were  held  outward  by  a  delicate-fitting  stay-plate, 
similar  to  Fig.  52,  while  the  incisors  were  retained  by  means  of 
a  piece  of  the  wire  G,  Set  l^o.  1,  connecting  the  bands  upon  the 


54 


THE    ANGLE    SYSTEM. 


lateral  incisors,  the  ends  being  soldered  to  the  labial  surfaces  of 
the  bands  and  the  intervening  portion  of  wire  lying  in  contact 
with  the  labial  surfaces  of  the  lateral  incisors.  These  retainers 
were  worn  until  the  cuspids  were  fully  erupted  and  all  the 
teeth  had  become  firm  in  their  new  positions. 

I  should  add,  this  patient  originally  suffered  from  greatly 
enlarged  tonsils. 

Fig.  56  shows  a  case  such  as  is  frequently  encountered  in 
some  of  its  modifications.  The  inlocked  cuspid  has  forced  the 
lateral  outward.  It  will  be  seen  by  studying  the  appliance  that 
it  served||the  double  purpose  of  pushing  outward  the  cuspid,, 
while  pulling  inward  the  lateral;  the  sheath  of  the  jack-screw 
being  cut  short,  allowing  it  to  travel  downward  over  the  spur 

Fig.  56. 


as  the  nut  is  turned,  until  its  base  finally  rests  against  the  band,, 
when  the  lateral  will  have  been  drawn  into  place,  aiid  will  rein- 
force the  anchor-tooth  in  resisting  the  moving  cuspid.  This  is 
another  instance  of  reciprocal  anchorage,  or  that  of  pitting  one 
irregular  tooth  against  another.  It  is  a  principle  of  great  value,. 
and  should  be  carefully  studied  and  made  use  of  whenever 
possible.  The  extra  pipe  on  the  sheath  of  the  jack-screw  wa& 
for  further  reinforcing  the  anchorage,  if  necessary,  by  hooking 
another  piece  of  the  wire  G  into  the  pipe,  and  fixing  the  other 
end  on  a  band  upon  the  first  bicuspid.  Keciprocal  anchorage 
may  be  gained  by  substituting  for  the  wire  attached  to  the  lateral 
the  small  traction-screw  C  and  B,  Fig.  1,  Set  No.  1.  They  were 
retained  by  uniting  their  bands  with  solder  and  recementing 
them  on  the  teeth. 

Fig.  57  shows  a  typical  case  and  the  combined  appliances 
actually   used.     The   laterals   were   inlocked,   the   left   cuspid 


PRACTICAL    CASES. 


55 


pushed  forward.     While  the  large  traction-screw  was  drawing 
back  the  cuspid,  it  was  assisted  by  the  loop  and  small  traction- 
screw  (see  Fig.  26),  acting  at  the  same  time  in  forcing  outward 
the  left  lateral;  another  instance  of  reciprocal  anchorage. 
The  other  lateral  was,  at  the  same  time,  forced  outward  by  the 

Fig.  57. 


')'^' 


jack-screw,  the  base  of  which  was  slipped  over  a  spur  soldered 
to  the  sheath  of  the  large  traction-screw,  again  making  use  of 
reciprocal  anchorage  by  assisting  the  traction-screw  in  resistance 
to  the  cuspid.  The  anchorage  of  the  jack-screw  might  be  rein- 
forced, as  already  described  in  Fig.  24.  Other  modifications  of 
this  combination  will  readily  suggest  themselves. 

Fig.  58. 


Fig.  58  represents  a  common  form  of  irregularity.  All  of 
the  incisors  are  pressed  inward,  not  enough  to  cause  inlocking 
of  the  same,  but  suflScientto  necessitate  the  closure  of  the  lower 
jaw  posterior  to  the  normal  occlusion,  in  some  instances  causing 
jumping  of  the  bite.     As  a  result,  there  is  not  sufficient  room 


56  THE    ANGLE    SYSTEM. 

for  the  cuspids,  and  in  the  effort  to  take  their  natural  positions 
(a  tendency  always  strong  with  them),  the  laterals  are  forced ' 
still  farther  inward,  as  well  as  partially  rotated.  The  aim  will 
be  to  force  forward  all  the  incisors,  making  correct  occlusion,  as 
well  as  providing  space  for  the  cuspids.  The  rotating  levers  are 
applied  to  the  laterals,  and  the  centrals  firmly  laced  to  the  same, 
while  all  are  being  forced  forward  by  the  jack-screws  soldered 
to  the  anchor-bands  (see  F,  Fig.  20),  the  chisel-ends  resting  in 
staples  (as  in  E,  Fig.  21),  soldered  to  the  bands  on  the  laterals 
to  also  permit  their  rotation.  The  cuspids  were  brought  down- 
ward by  the  methods  shown  in  Fig.  36  or  Fig.  39. 

Fig.  59  represents  the  case  of  a  little  girl,  eight  and  one-half 
years  of  age.  The  centrals  were  inlocked,  the  left  one  being 
also  greatly  twisted.     As  soon  as  they  had  sufficiently  emerged 

Fig.  59. 


fill  II'!! 


P,   i'TVMl 


from  the  gums  they  were  banded.  The  union  of  the  ends  of 
the  bands  was  made  at  the  disto-labial  angle.  Small  holes  were 
made  in  these  united  ends,  through  which  was  slipped  a  piece  of 
one  of  the  small  levers  L,  Set  ISTo.  1.  The  notched  ends  of  the 
jack-screws  engaged  this  wire  lever.  The  base  of  the  sheaths 
was  secured  by  being  slipped  over  the  ends  of  the  clamp-band 
screws.  (See  J,  Fig.  20.)  Rotation  of  the  central  was  accom- 
plished at  the  same  time  the  teeth  were  being  moved  out,  by 
occasionally  tightening  a  wire  ligature  surrounding  the  spring 
wire  and  a  spur  soldered  to  the  labial  surface  of  the  band.  After 
the  teeth  had  been  moved  in  the  desired  position,  they  were  re- 
tained by  the  appliances  for  a  few  days,  until  all  tenderness  had 
subsided,  when  the  bands  upon  the  centrals  were  united  by  sol- 
der, re-cemented,  and  the  rest  of  the  apparatus  dispensed  with. 
The  occlusion  of  the  lower  teeth  is  usually  sufficient  to  retain 


PRACTICAL    CASES.  .  57 

such  teeth  as  have  been  moved  out  of  inlock,  after  they  have 
been  steadied  in  their  new  position  for  a  few  days  by  an  appli- 
ance. But  in  this  case  the  retaining  bands  were  worn  until  the 
lateral  incisors  had  fully  erupted,  in  order  to  prevent  the  possi- 
bility of  their  again  overlapping. 

Fig.  60  shows  a  malposed  lateral  and  central.  The  base  of 
the  jack-screw  was  soldered  to  a  band  on  the  opposite  cuspid, 
and  reinforced  by  a  spur  resting  against  the  first  bicuspid,  as 
also  by  the  large  traction-screw,  which  is  hooked  into  a  tube,  D, 
Set  No.  1,  soldered  to  the  labial  surface  of  the  band.  The 
screw  passes  in  front  of  the  incisors  through  a  tube  (against 

Fig.  60. 


w  '    ■  11,1,1  7 

which  the  nut  works)  soldered  to  a  band  on  the  labial  surface  of 
the  lateral  incisor.  In  this  case  the  left  central  and  lateral  were 
wedged  forward  in  the  line  of  arch,  closing  the  space  between 
the  centrals  and,  at  the  same  time,  providing  space  for  the  out- 
moving  cuspid.  The  large  screw  was  beaten  flat  and  polished 
before  insertion. 

I  have  sometimes  closed  similar  spaces  between  the  incisors 
by  the  appliance  shown  in  Fig.  61,  which  consists  of  tubes,  C, 

Tig.  61. 


Set  'No.  1,  soldered  to  the  ends  of  a  piece  of  the  band  material 
long  enough  to  nearly  inclose  the  four  incisors.  The  small 
traction-screw  B  is  inserted  in  the  tubes,  and  the  space  contracted 
by  turning  the  nut. 

Figs.  62,  63,  and  64  show  other  simple  and  convenient  ways 
of  moving  a  tooth  into  line.     In  Fig.  62  the  anchorage  for  the 


58 


THE    ANGLE    SYSTEM. 


ligature  is  a  sheath  of  the  jack-screw  J,  Fig.  20,  slipped  over 
the  end  of  the  screw  upon  the  molar  clamp-band.  Force  is 
exerted  bj  occasionally  tightening  the  wire  ligature  around  the 
sheath  and  tooth  to  be  moved.  In  some  instances  the  sheath 
may  be  dispensed  with,  as  in  Fig.  63.  Another  modification  is 
shown  in  Fig.  64,  which  consists  of  a  pipe  (R,  Set  No.  1)  soldered 

Fig.  63. 


J^'iG.  64. 


perpendicularly  to  the  side  of  the  clamp-band,  into  which  is 
hooked  a  piece  of  the  wire  G,  Set  No.  1,  which  rests  against 
some  suitable  tooth,  to  assist  the  anchor-tooth;  the  anchor-wire 
and  the  tooth  to  be  moved  being  encircled  by  a  wire  or  rubber 
ligature. 

Fig.  65  is  a  side  view  of  a  very  marked  case  of  irregularities- 

Fig.  65. 


of  the  teeth  of  both  arches,  the  patient  being  a  young  lady  of 
sixteen  years.  The  superior  arch  was  much  compressed  in 
front,  the  incisors  greatly  twisted  and  overlapping,  and  the- 
cuspids  very  prominent,  as  shown  in  Fig.  66.  The  first  molars- 
and  bicuspids  were  also  more  or  less  malposed,  while  the  inferior- 
arch  was  much  contracted,  and  all  the  teeth  anterior  to  the  first 


PRACTICAL    CASES. 


59 


molars  were  very  irregular.  The  treatment  consisted  in  estab- 
lishing correct  occlusion  by  forcing  the  malposed  teeth  into  their 
correct  positions  in  the  arches.     This  was  accomplished  in  the 


Fig.  66. 


^^'-'M\ 


Fig.  67. 


lower  jaw  by  means  of  the  expansion  arch  F,  anchor-tube  and 
clamp-band  D,  wire  ligatures  and  bands,  as  shown  in  Fig.  67; 
also  shown  in  position  in  Fig.  68.  The  bicuspids  were  moved 
outward  by  wire  ligatures  occasionally  tightened  by  twisting^ 


60 


THE    ANGLE    SYSTEM. 


while  at  the  same  time  and  by  the  same  means  the  incisors 
were  being  drawn  into  proper  positions,  and  made  to  conform  to 
the  shape  of  the  wire  arch  passing  in  front  of  them.  They 
were  also  moved  forward  at  the  same  time  by  the  tightening 
of  the  nuts  in  front  of  the  anchor-tubes  upon  the  molars,  thus 
providing  more  space  for  the  bicuspids  as  they  were  forced  out- 
ward. The  cusj^id  was  rotated  with  a  wire  ligature,  attached  to 
a  spur  upon  the  disto-lingual  angle  of  the  band,  while  force  was 


Fig.  69 


f< 


"r\mM 


Pig.  70. 


c;i\>- 


^._A7 


heing  exerted  in  an  opposite  direction  upon  the  mesio-labial 
angle  of  the  tooth,  by  a  rubber  wedge  stretched  between  the 
tooth  and  the  -svire  arch,  all  as  correctly  shown  in  the  engraving. 
Fig.  69  shows  the  case  nearhig  completion.  After  the  move- 
ment of  the  teeth  had  been  completed  they  were  retained  for  about 
two  weeks,  until  all  tenderness  had  subsided,  by  the  appliance 
already  in  position  and  shown  in  Fig.  69.  The  appliance  was 
then  removed  and  the  teeth  permanently  retained  as  seen  in  Fig. 
70.     The  cuspids  were  carefully  banded,  and  the  ends  of  a  piece 


PRACTICAL    CASES.  61 

of  the  wire  Gr,  Set  No.  1,  were  soldered  to  tlie  lingual  sur- 
faces of  the  bands,  the  wire  resting  in  contact  with  the  lingual 
surfaces  of  the  incisors,  and  preventing  their  again  moving  in- 
ward, as  also  resisting  lateral  pressure  from  the  cuspids.  The 
bicuspids  were  prevented  from  moving  inward  by  pieces  of  the 
wire  G,  resting  on  the  lingual  surfaces  and  held  in  position  by 
their  anterior  ends  inserted  into  pipes  (R)  soldered  to  the  disto- 
lingual  surfaces  of  the  bands.  The  distal  ends  of  the  wires 
were  made  to  rest  in  small  cavities  formed  in  the  mesial  sur- 
faces of  the  first  molars,  one  of  which  had  long  been  covered 
by  a  gold  crown. 

The  teeth  in  the  upper  arch  were  forced  into  their  correct 
positions  by  an  appliance  similar  to  that  shown  in  the  treatment 

Fig.   71. 


'^ 


of  the  lower  arch  already  described.  The  incisors  were  moved 
forward  and  rotated  by  means  of  the  ligatures  and  tightening 
of  the  nuts  in  front  of  the  anchor-tubes,  while  pressure  was  ex- 
erted upon  the  prominent  cuspids  and  bicuspids  by  the  spring 
of  the  wire  arch  intensified  by  intervening  wedges  of  rubber. 
The  first  miolars  were  rotated  at  the  same  time  by  the  tubes  upon 
the  anchor-bands  being  so  adjusted  that  rotating  force  was  ex- 
erted by  the  spring  of  the  wire  arch.  After  the  teeth  had  been 
moved  they  were  retained  in  the  way  described  for  the  retention 
of  the  teeth  in  the  lower  arch,  with  the  exception  that  one  con- 
tinuous piece  of  the  wire  was  used,  accurately  shown  in  Fig. 
71. 

This  method  of  retention  is  useful  in  all  cases  of  this  class. 
Considerable  accuracy  is  necessary  in  the   adjustment  of  the 


62  THE  -ANGLE    SYSTEM. 

band,  wire,  etc. ;  if  found  slightly  longer  than  necessary,  it  is 
easily  shortened  by  bending  it  to  conform  to  the  circles  of  the 
teeth  by  jneans  of  a  burnisher  pressed  against  the  wire  in  the 
region  of  the  interdental  spaces.  If,  after  a  time,  it  is  found 
that  one  of  the  intervening  teeth  shall  have  moved  slightly  in- 
ward, it  should  be  again  moved  outward  by  a  wedge  of  rubber 
stretched  between  retaining-wire  and  tooth  for  a  few  days.  The 
wedge  is  then  removed,  and  the  soft  wire  burnished  or  driven 
outward  in  contact  with  the  readjusted  teeth.  The  distal  ends 
of  the  retaining-wire  should  always  be  set  in  cement,  and  the 
pits  should  be  carefully  filled  after  the  removal  of  the  retainer. 
The  retainers  in  the  case  here  shown  were  worn  for  one  year. 
They  were  so  compact  and  cleanly  that  the  patient  was  in  no- 
wise inconvenienced,  and  the  imj)rovement  in  her  appearance 
after  the  treatment  can  be  better  imagined  than  described. 

Section  II.     Jumping  the  Bite. 

Fig.  72  truthfully  represents  the  side  view  of  a  case  of  in- 
creasing prominence  of  the  anterior  upper  teeth,  the  cause  of 
which  I  believe  was  clearly  traceable  to  the  premature  loss  of 
the  inferior  first  molars.     The  occlusion  of  the  second  inferior 

Fig.  72 


molars  with  the  superior  first  permanent  molars  is  well  shown 
in  the  cut;  and  as  this  occlusion  naturally  continued  with 
the  inevitable  tipping  forward  of  the  inferior  second  molar 
into  the  space  vacated  by  the  first  molar,  the  lower  jaw  was 
gradually  drawn  backward  until  the  jumping  of  the  bite  of  the 
developing  cuspids  and  bicuspids  had  taken  place.  At  the  same 
time  the  compression  of  the  lateral  halves  of  the  superior  arch, 
in  order  to  better  conform  to  the  decreasing  size  (birecession) 
of  the  lower  arch  naturally  followed,  producing,  as  is  here  well 
shown,  the  condition  which  is  similar  to  thousands  of  cases 


PRACTICAL    CASES. 


63 


resulting  from  the   extraction   of  the  inferior  first  molars  by 
ignorant  or  unscrupulous  practitioners. 

The  treatment  consisted  in  widening  the  upper  arch  suffici- 
ently to  permit  of  the  lower  jaw  being  moved  forward,  and 
there  retained  until  the  habit  of  normal  occlusion  had  been  re- 
-established.     The  arch  was  expanded  by  means  of  the  wire 


arch  B,  and  anchor  clamp-bands  D,  as  shown  in  Set  No.  2.  The 
•centrals  and  laterals  were  moved  outward,  and  rotated  by  occa- 
sionally tightening  wire  ligatures  encircling  the  arch  and  spurs 
soldered  to  bands  upon  the  moving  teeth.  All  as  clearly  shown 
in  Fig.  73. 

Fig.  74  correctly  represents  the  case  as  seen  after  the  expan- 

FiG.  74. 


sion  of  the  arch  was  completed,  the  deciduous  second  molars 
having  in  the  mean  time  been  lost. 

Fig.  75  shows  the  lower  jaw  moved  forward  to  its  correct 
position,  where  it  was  retained  by  means  of  a  spur  imbedded  in 
the  inferior  permanent  molar,  thus  compelling  the  normal 
closure  of  the  jaw.     The  retention  of  the  upper  anterior  teeth 


64 


THE    ANGLE    SYSTEM. 


was  accomplished  wholly  by  the  proper  occlusion  with  the 
lower.  The  spur  has  now  been  worn  six  months,  and,  I  believe, 
might  be  discontinued  without  fear  of  recession  of  the  jaw ; 
but,  as  it  occasions  no  inconvenience,  it  will  be  worn  for  a  few 
months  longer,  or  until  the  eruption  of  the  second  superior 
bicuspid  shall  necessitate  its  being  gradually  shortened  by  grind- 
ing. 

Fig.  75. 


It  seems  to  me  that  jumping  the  bite  is  not  difficult  of  accom- 
plishment, and  is  a  most  natural  and  advisable  plan  of  treat- 
ment where  the  age  of  the  patient  and  other  conditions  are 
proper. 

Fig.  76  shows  another  case  of  very  marked  irregularity,  where 

Fig.  76. 


both  centrals  and  laterals  and  right  cuspid  were  greatly  turned  ; 
they  were  also  pushed  forward,  as  shown  in  Fig.  77. 

Fig.  78  shows  the  appliances  as  adjusted  at  the  commence- 
ment of  the  treatment.  It  will  be  seen  that  the  cuspids  are  being 
moved  backward  into  the  spaces  from  which  the  first  bicuspids 
have  been  extracted,  by  means  of  the  large  traction-screws  (A 
and  D,  Set  No.  1),  adjusted  and  operated  as  described  on  page  27. 


I'EACTICAL    CASES. 


65 


It  will  also  be  noticed  that  the  angle  of  the  traction-screw 
on  the  right  is  hooked  over  a  spur  (soldered  at  right  angles  to 
the  band,  instead  of  being  hooked  into  the  short  tube  as  on  the 
other  side),  thus  concentrating  all  the  force  on  one  side  of  \hv 
tooth  as  it  moved  backward. 

The  central  incisors  are  being  rotated  by  means  of  the  lever, 

Fig.   77. 


as  described  in  Fig.  34,  Their  prominence  was  also  reduced  at 
the  same  time  by  means  of  the  occipital  bandage  and  traction- 
bar,  as  described  on  page  39. 

Fig.  79  exhibits  the  case  after  being  acted  upon  bj  the  appli- 
ances already  described.  They  were  retained  by  uniting  with 
solder  the  bands  and  re-cementing  them  upon  the  centrals,  while 

Fio.  78. 


the  traction-screws  retained  the  cuspids.  The  rotation  of  the 
lateral  incisors  was  accomplished  with  the  rotating  levers  in  the 
usual  way,  securing  the  ends  of  the  levers  by  ligatures  attached 
to  the  distal  ends  of  the  traction-screws.  After  they  were  rotated, 
the  bands  were  removed,  united  with  solder  to  the  bands  upon 
the  centrals,  and  all  reset  on  the  teeth  with  cement.     The  trac- 

5 


66 


THE    ANGLE    SYSTEM. 


tion-screws  and  biuids  upon  the  cuspids  were  removed,  and  the 
case  then  presented  the  appearance  shown  in  Fig.  80.  The 
retaining-bands  were  worn  one  year,  after  which  the  teeth 
showed  no  tendency  to  return  to  their  former  positions. 


Fig.  79. 


J5f*  A^  ''I 


mx . 

V/'^   "M 


Fig.  80. 


^ 


Section  III.     Excessive  Protrusion  op  the  Upper  Teeth. 

Fig.  81  represents  a  typical   case  of  a  very  marked  class  of 
dental  irregularities,  quite  common  and  always  unsightly.     The 

Fi(i.  81. 


principal  characteristic  is  the  excessive  prominence  of  the 
superior  incisors,  laterals,  and  cuspids.  The  upper  lip  is  always 
short,  probably  due  to  lack  of  development  from  being  held  in 


PRACTICAL    CASES.  67 

ail  abnormal  position,  and  through  inability  to  close  the  lips 
over  the  prominent  teeth.  The  lower  jaw  is  generally  short, 
and  the  occlusion  of  the  molars  and  bicuspids  is  usually  good, 
although  posterior  to  the  normal.  Asa  result  the  lateral  halves 
of  the  superior  arch  are  commonly  closer  than  normal,  so  as  to 
be  better  accommodated  to  the  smaller  circle  of  the  lower  arch. 
The  lower  incisors  are  more  or  less  irregular,  and  their  cutting- 
edges  always  occupy  a  higher  plane  than  normal,  doubtless 
owing  to  the  lack  of  working  occlusion.  As  a  result  of  the 
frequent  attempts  at  complete  closure  of  the  mouth,  the  lower 
lip  is  forced  between  the  upper  and  lower  incisors,  and  exerts 
pressure  outward  upon  the  superior  and  inward  upon  the  lower 
incisors,  which  intensifies  the  malpositions  of  both.  Tliis  form 
of  irregularities  is  usually  associated  with  conditions  of  the 
nasal  passage  which  necessitate  mouth-breathing. 

Fig.  82. 


Fig.  82  represents  a  side  view  of  a  case  of  a  child  eight  years 
old,  whose  nasal  passage  was  obstructed  for  three  or  four  years, 
necessitating  mouth-breathing.  The  superior  centrals  had  erup- 
ted much  anterior  to  their  proper  positions,  their  labial  surfaces 
nearly  at  right  angles,  while  the  laterals  had  not  yet  erupted. 
The  deciduous  cuspids  and  molars  were  in  position,  as  well  as 
the  first  permanent  molars.  As  the  mouth  was  held  open  so 
much  of  the  time,  the  lower  jaw  was  either  gradually  forced 
back  from  its  normal  occlusion  or  prevented  from  developing, 
while  the  upper  arch  contracted  laterally,  in  order  to  better 
accommodate  the  occlusion  to  the  smaller  circle  of  the  retreating 
lower  arch.  The  development  of  the  upper  lip  seemed  to  have 
been  arrested,  and  had  but  little  restraining  influence  upon  the 
upper  incisors,  which  were  being  acted  upon  unfavorably  by 
the  forcing  of  the  lower  lip  l)etween  the  upper  and  lower 
incisors,  in  the  frequent  attempts  at  swallowing.     This  pressure 


68  THE    ANGLE    SYSTEM. 

of  the  lip  had  also  exerted  an  influence  upon  the  lower  incisors. 
They  were  becoming  bunched  and  forced  inward,  thereby  allow- 
ing more  space  for  the  lip  to  occupy  between  the  upper  and 
lower  incisors.  The  conditions  then  were  favorable  for  the 
development  of  excessive  protrusion  of  the  upper  anterior  teeth 
and  all  the  accompanying  deformities  already  described  in  the 
case  of  the  adult. 

The  plan  of  treatment  of  these  cases  should  vary  according 
to  the  age  of  the  patient.  In  the  present  instance  the  child 
was  first  referred  to  the  rhinologist  for  treatment  of  the  nasal 
passages.  He  having  been  successful,  eflbrts  were  then  directed 
to  the  restoring  of  the  normal  occlusion  of  the  teeth. 

The  central  incisors  were  rotated  after  the  manner  described 
in  double  rotation.  The  lower  incisors  were  made  to  occupy 
their  correct  positions  in  the  arch,  after  plan  shown  in  Fig.  51, 

Fig.  83: 


and  were  also  slightly  shortened  by  grinding.  The  upper  arch 
was  expanded  laterally  to  permit  the  movement  of  the  lower 
jaw  forward  so  that  the  teeth  might  occlude  normally,  as  shown 
in  Fig.  83.  Breathing  through  the  nose  was  encouraged,  and 
the  patient  directed  to  keep  the  lips  closed  and  teeth  in  proper 
occlusion  as  much  of  the  time  as  possible,  and  I  had  the  satis- 
faction of  seeing  the  habit  of  normal  occlusion,  as  well  as  nor- 
mal breathing,  re-established. 

In  the  treatment  of  cases  fully  developed,  it  would  be  useless  to 
attempt  to  restore  normal  occlusion,  as  in  the  case  last  described 
— viz,  widening  the  upper  arch  and  moving  the  lower  jaw  for- 
ward. The  general  plan  of  treatment,  then,  is  as  follows  :  First, 
to  compress  the  superior  incisors  in  their  sockets.  Second,  to 
reduce  the  size  of  the  superior  arch  by  extracting  one  or  both 
of  the  first  Ijicuspids,  and  move  the  incisors  and  cuspids  back- 
ward. Third,  to  correct  the  malpositions  of  the  inferior  incisors 
and  cuspids,  and  reduce  their  length  by  grinding.     Fourth,  to 


PRACTICAL    CASES.  69 

•establish  normal  breathing  and  normal  closure  of  the  lips. 
For  accomplishing  this  the  Set  No.  2  (see  Figs.  2  and  3)  was 
especially  designed,  and  comes  the  nearest  to  the  ideal  of  all 
appliances  yet  devised. 

The  anchor-bands  and  tubes  D  are  made  to  encircle  the  first 
molars.  The  ends  of  the  wire  arch  B  are  slipped  tii rough  the 
tubes.  The  anterior  part  of  the  arch  is  held  in  position  by 
bands  on  the  central  incisors,  having  notches  formed  in  the 
united  ends  upon  the  mesio-labial  surfaces,  into  which  the  arch 
rests,  as  shown  in  Fig.  84. 

Fig.  84. 


Force  is  exerted  upon  this  wire  arch  by  heavy  elastic  bands 
attached  to  the  head-gear,  as  in  Fig.  85.  This  force  is  received 
iind  transmitted  to  the  wire  arch  by  means  of  the  traction-bar 
A,  Set  ISTo.  2,  the  standard  seen  upon  the  center  of  the  traction- 
bar  engaging  the  delicate  ball  upon  the  center  of  the  wire  arch. 
The  hooks  upon  the  ends  of  the  traction-bar  recei^-e  the  ends 
of  the  elastics.  Any  degree  of  force  may  be  exerted  upon  the 
prominent  teeth  by  increasing  or  diminishing  the  tension  or 
size  of  the  elastics.  The  force  received  from  the  head-gear  acts 
on  the  wire  arch  through  the  ball-and-socket  joint.  The  ends 
of  the  traction-bar  may,  therefore,  be  casually  moved  in  any 
direction.  The  advantage  is  that  in  consequence  of  the  freedom 
of  motion,  ajar  or  shock  upon  the  traction-bar  ends  will  not  be 
transmitted  to  the  tender  teeth.  As  the  bandage  and  bar  are  to 
be  worn  at  night,  contact  with  the  pillow  would  be  liable  to 
occasion  pain  were  it  not  for  this  freedom  of  movement,  an  ad- 
vantage possessed  by  no  other  device  of  its  class  and  appreciable 


70 


THE    AX(5LE    .SYSTEM. 


by  both  patient  aucT  operator.  The  usual  method  is  to  rigidly 
attach  the  traction-bar,  or  its  equivalent,  to  a  swaged  or  vulcanite 
cap  covering  and  firmly  resting  against  all  the  teeth  to  be  moved. 

At  such  times  as  the  head-gear  and  elastics  are  not  worn, 
provision  is  made  for  holding  wliat  has  been  gained  by  delicate 
rubber  ligatures  E,  E,  Set  ISTo.  2,  which  are  slipped  over  the 
distal  ends  of  the  tubes  on  the  molars,  stretched  forwnrd,  and 
tied  with  silk  ligatures  in  front  of  the  small  collars  which 
encircle  the  wire  arch  opposite  the  cuspids,  as  seen  in  Fig.  84. 

These  collars,  being  rigid,  prevent  the  ligatures  from  sliding 
back,  and  thus  exert  a  gentle  but  constant  traction  on  the  mov- 

PiG.  85. 


ing  teeth,  and  prevent  them  from  springing  back  and  interfer- 
ing with  the  process  of  repair.  Of  course,  these  ligatures  are 
worn  constantly.  Another  advantage  of  the  device  is,  that  not 
only  is  the  prominence  of  the  teeth  reduced,  but  the  malposed 
teeth  are  gradually  forced  to  take  regular  positions  and  conform 
to  the  shape  of  the  ideal  arch  (as  it  is  forced  backward  through 
the  tubes  on  the  molars),  an  action  impossible  with  devices  hav- 
ing fixed  caps  of  vulcanite  or  gold.  Still  another  advantage  is, 
that  if  the  arch  should  need  lateral  expansion,  as  is  frequently 
the  case,  it  may  be  accomplished  at  the  same  time  the  teeth  are 
being  moved  backward,  by  lacing  to  the  wire  arch  such  teeth  as 
need  to  be  moved  outward.  But  in  obstinate  cases  the  jack- 
screw,  notched  at  each  end  and  resting  in  contact  with  pieces  of 


PRACTIGAl.    CASES. 


71 


the  G  wire,  may  be  employed,  as  clearly  shown  in  Fig.  86, 
wherein  two  rubber  wedges,  shown  resting  l)etweon  the  bicuspids 
and  wire,  were  used  to  move  them  farther  outward  than  was 
possible  with  the  straight  wire.  Tlie  head-gear  proper  has  been 
greatly  improved,  as  a  result  of  much  experimenting,  and  is  cor- 
rectly shown  in  Fig.  85.  It  consists  of  a  non-collapsil)lc  spring 
rim,  adjustable  as. to  size  l»y  the  nut  on  the  side.  The  netting 
covering  the  head  is  adjusted  by  tightening  or  loosening  the  silk 
cord  connecting  the  rim  with  the  heavy  silk  netting,  which  pro- 
vides for  thorough  ventilation.  One  great  advantage  of  this 
head-gear  is,  that  the  rim  receives  the  force  and  distributes  it 
equally  over  the  entire  l)ack  of  the  head,  so  that  much  greater 


pressure  can  be  borne  without  causing  headache,  a  common  re- 
sult of  the  old  styles,  through  interference  with  the  circulation  hj 
local  pressure.  The  engraving  shows  two  elastics  on  each  side, 
one  attached  to  the  cap  above  and  one  below  the  ear.  The  points 
of  attachments  are,  however,  to  be  varied  according  to  the  re- 
quirements of  the  case.  In  nearly  every  instance  it  will  be  found 
that  the  teeth  should  not  only  be  moved  backward,  but  be  de- 
pressed in  their  sockets.  For,  if  merely  moved  backward,  the 
teeth  will  present  such  a  lengthened  appearance  that  the  result 
will  be  nearly  as  bad  as  the  original  deformity.  Therefore,  it 
would  be  plain  to  any  careful  observer  of  these  cases  that  the  plan 
so  often  advocated,  of  exerting  force  from  the  molars  only,  is 
wrong,  for  tipping  of  the  anterior  teeth  is  the  only  result  by 
anchoi-age  from  that  point;  but  with  the  occipital  anchorage  there 
is  perfect  control  over  the  direction  of  the  force,  by  simply  making 


72  THE    ANGLE    SYSTEM. 

the  attachments  to  the  anterior  elastics  farther  forward  or  back- 
ward. Or  if  elong-atioii  of  the  teeth  he  necessary,  the  lower 
ligature  only  is  used,  dispensing  with  the  upper  or  using  only  a 
very  light  one.  These  ligatures  may  l)e  doubled  after  the  patient 
has  become  well  accustomed  to  wearing  them.  The  teeth  are 
to  be  retained  by  the  wire  arch,  Fig.  84  (the  head-gear,  tractio\i- 
bar,  and  delicate  ligatures  being  of  course  dispensed  wdth), 
which  is  kept  in  position  by  passing  a  delicate  drill  through  the 
tubes  on  the  anchor-teeth,  and  inserting  neatly-fitting  pins  into 
the  holes  thus  made,  as  in  Fig.  23.  This  method  of  retaining  is 
very  eiFectual,  and  as  long  as  the  appliance  is  so  worn  the  teeth 
cannot  change  their  proper  positions.  But  as  it  is  somewhat 
unsightly,  and  the  patient  has  already  worn  it  for  some  time, 
its  removal  will  l)e  requested;  and,  it  being  of  great  impor- 
tance in  these  cases  tliat  the  teeth  be  firmly  retained  for  a  long 

Fig.  87. 


period  (at  least  one  3'ear),  a  device  less  ol)jectional»le  in  appear- 
ance should  be  used.  After  much  experimenting,  I  find  that 
the  appliance  shown  in  Fig.  87  effectually  meets  the  require- 
ments. It  is  retention  by  means  of  the  occipital  bandage  or 
head-gear,  but  should  never  be  made  use  of  immediately  after 
the  movement  of  the  teeth  has  been  accomplished,  but  only  after 
the  teeth  have  been  retained  by  the  other  appliances  for  at  least 
two  months,  or  long  enough  to  allow  the  teeth  to  have  become 
thoroughly  rested  in  their  new  positions  and  somewhat  firmly 
established.  The  arch,  bands,  and  tubes  upon  the  molars,  as 
well  as  on  the  incisors,  should  then  be  removed,  and  the  teeth 
thoroughly  cleansed.  After  which,  careful  impressions  are 
taken  of  l)oth  upper  and  lower  jaws,  and  accurate  models  made. 
Careful  comparison  of  the  natural  teeth  with  these  models  is  to 
be  made  from  time  to  time,  in  order  to  detect  any  unfavorable 
changes  should  they  occur. 

The  retaining  appliance.  Fig.  87,  is  then  adjusted,  and  is  to  be 
worn  at  night-time  only,  thus  allowing  the  patient  entire  free- 
dom from  all  appliances  during  the  day.     It  consists  of  a  seg- 


J'RACTICAL    CASES.  73 

nietit  of  the  wire  arch  (B)  long  enough  to  p;iss  in  front  of  the 
incisors  find  cuspids,  and  carefully  hent,  so  that  it  will  rest  in 
contact  with  them.  Two  short  pieces  of  the  wire  G,  Set  No.  1, 
are  soldered  at  right  angles  to  this  wire,  opposite  the  front  of 
tlie  central  incisors.  They  are  long  enough  to  admit  the  ends 
being  l)ent  over  the  cutting-edges  of  the  incisors,  and  the  hooks 
so  formed,  will  hinder  the  appliance  from  sliding  upward  against 
the  gum.  The  device  is  prevented  from  sliding  laterally  l)y  a 
short  piece  of  the  wire  at  a  soldered  point  between  the  centrals. 
This  spur  should  rest  in  the  depression  between  these  teeth; 
opposite  is  the  delicate  ball  which  engages  the  socket  in  the 
standard  of  the  traction-bar,  all  accurately  shown  in  Fig.  87. 
It  is  adjusted  by  sliding  it  into  position  upon  the  teeth,  and,  if 
it  has  been  carefully  made,  will  not  be  displaced  after  the  head- 
gear and  traction-bar  have  been  adjusted.  This  device  may  also 
be  made  of  vulcanite,  having  a  spur  imbedded  at  the  proper 
point  corresponding  with  the  delicate  ball  which  engages  the 
traction-bar. 

Section  1A^.     Excessive  Protrusion  of  the  Lower  Teeth. 

Another  well-defined  type  of  irregularity  is  characterized  by 
excessive  prominence  of  the  lower  jaw,  or  orthognathism,  and 
which  in  extreme  cases  presents  the  most  noticeable  deformity 
w^e  are  called  upon  to  correct.  Unlike  the  type  last  described, 
the  inferior  dental  arcli  is  generally  large,  and  quite  free  from 
irregularity,  while  the  upper  arch  is  usually  small  and  the  teeth 
crowded,  so  that  the  inferior  incisors  close  anterior  to  the 
superior,  producing  the  greatest  malocclusion  of  the  remaining 
teeth.  The  treatment  varies  according  to  the  age  of  the  patient. 
If  begun  at  a  proper  age,  as  soon  as  the  deformity  is  manifest, 
or  even  up  to  the  twelfth  or  fourteenth  year,  it  is  not  difficult  to 
bring  about  retraction  of  the  jaw  by  means  of  force  exerted  by 
the  heavy  elastic  l)ands  and  head-cap  (already  described  in  con- 
nection with  Set  Xo.  2),  attached  to  a  metallic  cap  covering  the 
chin,  all  as  shown  in  Fig.  5. 

Fig.  88  represents  the  side  view  of  a  case  of  a  child  nine 
years  of  age.  The  permanent  incisors  of  the  lower  jaw  had 
erupted ;  the  superior  centrals  had  also  erupted  and  were 
twisted  nearh'  at  right  angles.  The  deciduous  cuspids  were  in 
position,  although  the  inferior  were  loosened  and  nearly  ready 
to  fall  out.     The  four  first  permanent  molars  were  present,  and 


74 


THE    ANGLE    SYSTEM. 


the  first  superior  bicuspids  were  beginning  to  emerge  from  the 
gum.  The  jaw  had  moved  forward  so  that  the  lower  incisors 
closed  anterior  to  the  superior,  all  as  correctly  represented  in 
the  engraving.  The  patient  could  not  retract  the  jaw  sufficiently 
to  bring  the  cutting-edges  of  the  incisors  in  contact  at  any 
point.  The  head-gear  and  chin-cap  were  worn  almost  constant!}^ 
for  six  weeks. 

Fig.  88: 


Double  rotation  of  the  superior  centrals  was  accomplished  by 
means  of  the  lever  already  described  in  double  rotation.  They 
were  retained  by  uniting  the  bands  with  solder  and  re-cement- 
ing them  upon  the  teeth,  and  at  the  end  of  six  weeks  the  jaw 
had  been  retracted  into  almost  a  normal  position,  presenting  the 
appearance  shown  in  Fig.  89.  The  chin-cap  and  head-gear 
were  worn  at  night-time  only,  and  dispensed  with  after  six 
months,  as  there  was  no  further  need  of  retractive  force. 

Fig.  89. 


The  first  examination  proved  the  patient  to  be  suffering  from 
greatly  enlarged  tonsils,  and  she  was  referred  to  the  rhinologist 
for  treatment. 

Fig.  90  shows  a  side  view  of  another  very  marked  case 
belonging  to  this  class  of  deformity.  Fig.  91  accurately  repre- 
sents the  upper  arch.  The  effect  of  the  deformity  npon  the 
appearance  of  the  patient  is  shown  in  Fig.  92.  The  treatment 
consisted  in  enlarging  the  upper  arch  by  means  of  the  expan- 


PRACTICAL    CAr;p> 


75 


sion-arch  E,  and  anchor  clamp-bands  and  tubes  D,  operated  as 
shown  in  the  case  ilkistrated  in  Fig.  68.  The  expansion-arch 
was  also  reinforced  as  described  on  page  45  and  illustrated  by 
Fig.  44. 


Fig    90. 


Fig.  91. 


•H.A. 


Fig.  92. 


While  this  was  V)eing  done,  the  head-gear  and  chin-retractor 
were  worn  as  much  of  the  time  as  possible.  At  the  end  of  two 
months  the  expansion  of  the  upper  arch  was  discontinued,  the 
teeth  retained,  and  the  patient  allowed  to  return  to  her  home  in 


76 


THE    ANGLE    SYSTEM. 


a  distant  city,  for  a  vacation  of  three  months.  This  was  done 
in  order  to  give  the  upper  jaw  an  opportunity  to  develop,  but 
the  wearing  of  the  chin-retractor  was  continued  faithfully.  At 
the  end  of  the  three  months  the  patient  returned,  and  the 
expansion  of  the  upper  arch  was  continued,  at  the  same  time 
increasing  the  tension  upon  the  chin.  At  the  end  of  two  months 
more  the  enlargement  of  the  upper  arch  had  been  completed, 
and  is  truthfully  represented  in  Fig.  93. 

Fig.  93. 


The  lower  jaw  had  been  moved  backward,  and  the  occluded 
teeth  presented  the  appearance  shown  in  Fig.  94. 


Fig,  94 


Exactly  what  changes  had  taken  phice  in  the  angle  of  the  jaw, 
or  temporo-maxillary  articulation,  it  is  impossible  to  say,  but  I 
am  thoroughly  convinced  that  the  body  of  the  jaw  had  been 
moved  backward  greatly.  The  principal  change,  however,  was 
the  instrumental  enlargement  of  the  upper  jaw.  The  improve- 
ment in  the  appearance  of  the  young  lady  can  Ije  better  imagined 
than  described,  and  the  changes  that  had  l)een  brought  about 


PRACTICAL    CASES. 


77 


were  such  as  to  encourage  attempt's  at  improvement  in  all  such 
cases.  But  in  cases  of  advanced  years,  my  experience  is  that 
it  is  useless  to  attempt  the  retraction  of  the  jaw.  All  that  we 
can  then  hope  to  accomplish  is  the  contraction  of  the  inferior 
dental  arch  and  the  enlargement  of  the  superior,  as  illustrated 
by  the  case  shown  in  Fig.  95.     The  upper  anterior  teeth  were 

Fig.  9-5. 


moved  outward  by  means  of  the  jack-screws  as  shown  in  posi- 
tion upon  the  teeth  in  Fig.  96,  and  described  in  the  treatment 
of  a  similar  case  on  page  53.  After  the  first  bicuspids  had 
been  extracted,  contraction  of  the  anterior  part  of  the  inferior 
arch  was  accomplished  by  means  of  the  traction-screws  hooked 


Fig.  9(J. 


into  staples  upon  l)ands  encircling  the  cuspids.  The  traction- 
screws  were  assisted  in  moving  the  cuspids  and  incisors  back- 
ward by  the  head-gear,  elastics,  and  traction-bar,  exerting  pres- 
sure upon  a  section  of  the  wire  arch  B,  Set  No.  2,  which  rested 
in  contact  with  the  incisors  and  cuspids  held  in  position  by  the 
attachment  of  the  band  to  the  ends  with  solder,  all  as  shown  in 


THE    ANGLE    SYSTEM. 


Fig.  97.  The  external  force  served  the  double  purpose  of  assist- 
ing the  traction-screws  in  moving  the  teeth  as  well  as  in  the  re- 
traction of  the  maxilla.  The  amount  accomplished  in  the  last 
mentioned  movement  was  quite  noticeable,  as  is  well  shown  in 
Fig.  98,  which  represents  the  completed  case.  In  the  adjust- 
ment of  Set  ^nTo.  2  it  is  usually  better  to  place  in  position  only 


the  anchor-bands  and  tubes  (D)  at  the  first  sitting,  or  at  most  the 
additional  bands  upon  the  incisors.  At  the  second  sitting  the 
arch  B  maybe  placed  in  position  and  worn  a  few  days  until  the 
patient  becomes  gradually  accustomed  to  wearing  it,  when  the 
head-gear  may  be  adjusted,  wath  light  tension  at  first,  gradually 
increasing  tlie   same,   as  well  as  the  number  of  hours  worn, 


Fig,  98. 


/-I^^^^^fes 


which  should  finally  include  as  much  of  the  time  as  possible,  in 
order  to  expedite  the  completion  of  the  case. 

The  wire  arch  B  should  be  bent  occasionally  as  the  case  pro- 
gresses, in  order  to  exert  pressure  on  such  laterals  or  cuspids  as 
need  to  be  restrained  while  moving  back;  and,  if  any  of  the 
teeth  should  show  tendency  to  bunching  or  overlapping,  this 
should  be  prevented  l)y  lacing  them  to  the  arch,  after  plans  of 


PRACTICAL    CASES.  79 

ligatures  shown  in  Fig.  28.  If  any  of  the  teeth  show  tendency 
to  lengthening,  this  should  also  be  prevented  by  bands  and 
notches  which  shall  engage  the  arch  B.  IN'ever  use  larger  liga- 
tures than  those  shown  at  E,  E,  Fig.  2,  accompanying  the  appli- 
ance, for  it  should  Ije  remembered  that  the  force  necessary  in 
moving  the  teeth  is  exerted  by  the  heavy  elastics  and  head-gear ; 
but  by  increasing  the  size  of  the  small  ligatures  disturbance  of 
the  anchor-teeth,  such  as  tipping,  elongating,  and  the  establish- 
ment of  faulty  occlusion  may  follow,  something  especially  to  be 
avoided  in  the  treatment  of  these  cases.  It  should  also  be 
remembered  that  no  moving  force  upon  the  teeth  should  be 
exerted  by  these  merely  retaining  ligatures. 

In  order  to  produce  room  for  the  irregular  teeth,  it  is  some- 
times necessary  to  extract  one  or  two  of  the  bicuspids.  Where 
the  loss  of  one  is  suthcient  the  moving  teeth  may  be  shifted 
laterally  in  order  to  fill  this  space,  by  inserting  a  folded  hand- 
kerchief or  a  small  cushion  between  the  face  and  heavy  elastic 
bands,  thus  exerting  lateral  pressure  upon  the  traction-bar  stand- 
ard and  wire  arch. 

The  wire  coiler  shown  at  ]Sr,  Fig.  8  A,  is  well  adapted  for 
curving  the  retaining-wire  G,  or  for  modifying  the  curves  in 
wire  arches  B  and  E.  This  may  thus  be  done  without  risk  of 
breaking  or  roughening  the  smooth  surfaces  of  the  wires,  as  is 
liable  to  occur  under  the  use  of  ordinary  pliers. 

The  new  regulating  pliers  (H,  Fig.  8  B)  for  elongating  the 
several  straight  or  curved  wire  appliances,  will  be  more  and 
more  appreciated  as  experience  shall  demonstrate  the  general 
utility  of  the  invention.  A  re-examination  of  the  devices  shown 
in  Figs.  10,  24,  25,  2G,  37,  56,  70,  and  71  will  make  obvious  the 
fact  that  any  section  of  the  wire  G,  if  inadvertently  cut  a  little 
short  for  its  designed  position,  may  be  repeatedly  pinched  witli 
the  pliers  until  its  length  shall  exactly  correspond  with  its  func- 
tion. If  desirable,  the  wire  may  be  so  stretched  while  in  situ, 
as  shown  and  described  on  page  -4:9. 

In  the  precise  adjustment  of  retaining-wires  the  novel  action 
of  the  regulating  pliers  is  especially  manifest. 


80  THE    ANGLE    SYSTEM. 


CHAPTER    VIIL 


GENERAL    SUGGESTIONS. 


I.  An  essential  preliminary  to  the  treatment  of-  a  case  is  a 
clear  conception  of  what  is  necessary.  This  can  be  done  only 
by  a  careful  study  of  both  models  and  natural  teeth,  occlusion 
and  facial  expression,  history,  etc. 

II.  It  is  best  to  first  attend  to  the  crowding  teeth,  rather 
than  those  most  irregular.  For  example  :  If  the  molars  and  bi- 
cuspids are  irregular,  and  expansion  indicated,  expand  first  and 
establish  correct  occlusion  in  that  region,  before  correcting  mal- 
positions of  the  incisors  and  cuspids. 

III.  Have  regular  times  for  seeing  the  patient;  be  punctual, 
and  insist  upon  punctuality  by  the  patient.  Always  carefully 
compare  the  orginal  models  at  each  sitting. 

IV.  It  is  not  enough  to  correct  the  malpositions  of  the  teeth 
in  one  arch,  but  also  to  establish  the  correct  occlusion  of  all  the 
teeth  and  restore  proper  facial  expression. 

Y.  Exercise  such  care  and  judgment  in  the  adjustment  of 
the  appliances  that  delays  from  slipping,  breaking,  or  changes 
will  be  avoided. 

VI.  In  moving  a  tooth,  the  best  result  is  obtainable  only  by 
recognizing  the  regular  and  proper  amount  of  force  necessary 
to  stimulate  absorption.  The  practice  of  applying  great  force 
at  irregular  intervals  serves  only  to  defeat  the  desired  object, 
for  it  retards  absorption  and  restoration,  causes  unnecessary 
pain,  excites  inflammation,  and  thereby  endangers  pulp-life.  It 
also  strains  the  appliances,  causing  much  delay  and  pain  to  the 
patient  by  repairs. 

Whether  the  pressure  be  constant  or  irregular,  a  safe  rule  is 
to  see  that  it  in  no  instance  exceeds  a  snug  feeling,  which  is  a 
true  indication  of  the  proper  amount  of  force. 

VII.  When  the  screw  is  used  in  moving  a  tooth,  and  the  pa- 
tient is  an  intelligent  one,  he  maybe  provided  with  a  wrench,  and 
instructed  to  tighten  the  nut  morning  and  evening,  thus  greatly 
economizing  the  time  of  both  patient  and  operator;  yet  the  patient 
should  be  seen  at  intervals ;  usually  twice  a  week  will  be  sufficient. 

VIII.  It  is  important  that  the  patient  shall  observe  care  ii4 
brushing  and  cleansing  the  teeth  while  wearing  the  regulating 
appliances,  and   the  preferable  dentifrice  for   this  purpose  is 


GENERAL    SUGGESTJONS.  81 

prepared  chalk,  followed  bv  castile  soap.  If  the  appliances  are 
kept  properly  cleansed,  the}^  will,  in  most  instances,  take  on  a 
beautiful  bronze  color,  far  more  pleasing  in  appearance  than 
when  made  of  gold,  besides  possessing  greater  strength. 

IX.  Each  succeeding  year  strengthens  the  conviction  tliat 
extraction  for  space  is  a  rare  necessity,  and  moreover  it  is  dith- 
cult  to  produce  the  best  results  without  the  full  complement  of 
teeth.  With  but  few  exceptions  it  will  seldom  be  found  that 
the  facial  expression  is  too  full  when  all  tlie  teeth  are  ideally 
arrano^ed  in  the  arches.  The  conservative  method  should  be 
first,  extraction  last.  Many  cases  are  greatly  complicated  by 
the  careless  extraction  of  one  or  more  teeth,  in  order  to  gain 
sufficient  space.  The  author  has  never  seen  a  case  where  the 
extraction  of  the  first  molar,  one  or  more,  has  not  been  followed 
by  more  or  less  irregularity,  sometimes  of  a  very  complicated 
nature.  No  one  can  long  practice  orthodontia  without  being 
impressed  with  the  important  relation  that  each  tooth  in  either 
arch  hears  to  all  the  rest,  nor  fail  to  note  the  disastrous  results 
often  following  the  loss  of  a  single  tooth. 

X.  Slight  irregularities  should  be  corrected,  because  the  turn- 
ing of  a  slightly  twisted  tooth,  or  the  correction  of  any  irregu- 
larity of  the  oral  teeth,  Avill  not  only  improve  their  appearance, 
but  refine  the  whole  facial  expression. 

XL  It  is  important  to  remember  that  the  pressure  should 
never  be  wholly  relinquished.  The  movements  of  a  tooth  may 
be.  arrested  as  often  as  is  necessary;  but  never,  by  the  removal 
of  pressure,  allow  the  tooth  to  spring  backward,  thus  interfering 
with  the  process  of  repair.  Disregard  of  this  principle  (as  has 
usually  been  necessary  in  the  ordinary  regulating  appliances, 
the  faulty  principles  on  which  their  construction  has  been  based 
necessitating  their  frequent  removal  for  purposes  of  modifica- 
tion and  cleansing)  has  been  the  occasion  of  nearly  all  the  pain 
and  soreness  in  regulating.  If  intelligently  conducted,  the 
movement  of  a  tooth  is  painless. 

XII.  Another  very  important  fact  to  be  remembered  is,  that 
support  and  perfect  rest  are  essential,  after  a  tooth  has  been 
moved  into  the  desired  position. 

XIII.  In  adopting  this  system  the  operator  should  carefully 
study  and  thoroughly  familiarize  himself  with  the  names  and 
uses  of  all  the  parts  of  these  appliances,  which  are  supplied  in 
sets  or   separately.     A  little    experience  will   enable   him    to 


8Z  TH'E    AXGLE    SYSTEM, 

readily  apply  them  to  any  case,  for  the  system  is  complete  in 
itself. 

XIY.  The  plate  has  no  place  in  this  system  as  any  part  of  a 
regulating  appliance,  and  only  in  rare  instances  as  a  retainer 
after  lateral  expansion  of  the  arch:  it  should  he  a  relic  of  the 
past. 

XV.  The  wire  arches  B  and  F  have  all  the  spring  possible. 
They  are,  therefore,  hard,  and  may  be  broken  if  care  is  not 
taken  in  bending  to  the  desired  shape.  They  are  made  long 
enough  to  include  the  largest  arch,  and  may  be  cut  to  suit  the 
smaller  ones. 

XVI.  In  applying  the  jack-screw,  the  sheath  should  be  used 
as  long  as  possible,  turning  the  nut  close  up  to  the  chisel  end 
before  cutting  the  sheath  to  the  desired  length. 

XVII.  In  making  the  attachments  of  tubes,  they  should  be 
grooved  with  a  round  file  at  the  point  of  contact,  to  make  a 
strong,  compact  appliance. 

XVIII.  The  motionless  retention  of  the  teeth  is  of  great  im- 
portance, but  it  will  seldom  be  attained  unless  proper  occlusion 
has  been  first  established.  A  retaining  appliance  should  be  so 
delicate  that  it  may  be  worn  without  inconvenience  to  the 
patient  until  perfect  firmness  has  been  established,  and  should 
rarely  be  under  the  control  of  the  patient. 

XIX.  It  is  not  necessary  to  separate  the  upper  from  the 
lower  teeth  by  some  contrivance  while  teeth  are  being  moved 
out  of  inlock,  so  that  the  occlusion  will  not  cause  interference 
with  the  moving  teeth.  The  author  has  never  yet  found  it 
necessary,  as  the  patient  will  invariably  avoid  biting  upon  the 
tender  moving  teeth. 

XX.  Failures  to  recognize  and  appreciate  the  artistic  require- 
ments in  the  treatment  of  dental  irregularities  are  frequent,  and 
as  easily  recognized  as  they  are  lasting.  All  who  hope  to  attain 
success  in  the  treatment  of  dental  irregularities  should  cultivate 
the  habit  of  observing  and  carefully  studying  the  normal  and 
abnormal  lines  of  the  human  face,  together  with  their  relations 
to,  and  dependence  upon,  the  teeth. 

An  appreciation  and  intelligent  application  of  the  principles 
of  art  must  ever  go  hand  in  hand  with  the  successful  treatment 
of  irregularities  of  the  teeth. 

XXI.  Irregularities  of  the  teeth  being  so  frequently  associ- 
ated with  some  pathological  obstruction  of  the  nasal  passages,  or 


GENERAL    SUGGESTIONS.  83 

naso-pharynx,  this  fact  should  he  ever  present  in  the  operator's 
mind  and  snitahle  examination  be  made ;  and  in  case  (as  is  often 
found)  the  oral  deformitj^  is  complicated  hj  the  presence  of  hy- 
pertrophied  faucial  tonsils,  adenoid  hypertrophies  in  the  vault 
of  the  pharynx,  or  obstruction  of  the  nasal  passages,  the  ortho- 
dontist's work  can  only  be  made  complete  by  the  added  assist- 
ance of  the  rhinologist  and  laryngologist. 

XXII.  If,  however,  a  dentist,  after  sufficient  experience,  linds 
himself  unsuited  for  this  class  of  work,  it  is  his  duty  to  refer 
patients  to  an  expert  orthodontist,  and  thus  promote  the  practice 
of  this  specialty  in  dental  surgery. 


84 


THE    ANGLE    SYSTEM. 


PAET  IL 

FRACTURES  OF  THE  MMILIM. 


CHAPTEK   I. 

TREATMENT    OF    FRACTURES    OF    THE    MAXILLA. 

The  limits  of  this  work  will  not  admit  of  a  general  discussion 
of  this  subject,  nor  is  it  deemed  necessary,  for  almost  any  of  the 
modern  works  on  surgery  contains  a  treatise  covering  the 
general  principles  of  the  treatment  of  fractures.  Especially 
commendable  is  Hamilton  on  Fractures. 

The  most  important  consideration,  after  securing  perfect 
apposition  of  the  parts,  is  that  they  shall  have  uninterrupted 

Fig    99. 


rest,  and  this  phase  of  the  subject  will  be  set  forth  strictly  with 
reference  to  certain  plans  for  securing  fixation  of  the  fractured 
maxillae  while  undergoing  the  healing  process;  plans  which  are 
original  with  the  author, 'and  have  been  successfully  employed 
in  an  extensive  experience  in  the  treatment  of  these  lesions. 

The  first  plan  is  that  of  firmly  and  immovably  holding  the 
injured  jaw  in  contact  with  the  firm  and  uninjured  jaw,  by 
means  of  wire  ligatures  wrapped  in  the  form  of  the  figure  eight,. 
around  buttons  attached  to  bands  encircling  suitable  opposite 
or  nearly  opposite  teeth,  as  shown  in  Fig.  99. 

All  the  teeth  are  thus  kept  in  perfect  occlusion,  and,  as  a  result, 
the  fractured  ends  of  the  bones  must  necessarily  be  in  apposition^ 


TREATMENT    OF    FRACTURES    OF    THE    MAXILL-E.  85 

SO  that  the  conditions  are  most  favorable  to  the  process  of 
repair;  for  it  will  be  apparent  upon  reflection,  that  no  matter  at 
what  point  the  fracture  has  occurred,  if  the  jaw  contains  sufii- 
€ient  teeth  and  they  are  placed  in  perfect  occlusion,  not  only  will 
the  fracture  be  properly  set,  but  the  powerful  muscles  will  be 
greatly  relaxed  and  the  parts  be  consequently  freed  from  that 
tension  and  tendency  to  displacement,  so  difficult  to  combat  in 
the  treatment  of  fractures,  in  the  long  bones  especially,  or  in 
the  maxilla?  when  the  jaws  are  kept  apart,  as  is  necessary  when 
the  heavy  interdental  splints  are  employed. 

Indeed,  we  believe  this  plan. to  be  a  most  natural  and  easy 
one,  for  the  cusps  of  the  teeth  lock  and  interlace  so  perfectly 
that  displacement  in  any  direction  is  impossible,  provided  the 
jaws  are  kept  closed.  And  in  this  we  are  further  assisted  by 
the  natural  contraction  of  the  powerful  muscles  of  mastication, 
it  being  necessary  in  most  cases  only  to  antagonize  the  anterior, 
feeble  depressor  muscles,  by  attachments  on  each  side  to  the 
cuspids,  or  other  teeth  in  this  region,  if  more  suitable. 

The  bands,  which  we  term  fracture-bands,  Fig.  100,  are  made 

Fig.   100. 


very  thin  and  strong,  are  adjustable,  and,  by  means  of  the  screw 
and  nut,  they  may  be  firmly  clamped  about  the  teeth.  Little 
buttons,  strong  and  of  sufficient  size  to  admit  the  requisite 
number  of  wraps  of  the  ligatures,  are  firmly  soldered  to  the 
band.  Care  should  always  be  exercised  to  work  the  band  well 
over  the  crown  of  the  tooth  and  down  upon  the  neck,  then 
tighten  the  nut  until  the  band  is  firmly  clamped,  being  careful 
not  to  weaken  the  band  by  crimping  or  tearing.  The  fingers 
alone  are  usually  sufficient,  although  a  dull  instrument  and 
mallet  (as  in  M  and  L,  Fig.  8  B)  may  be  used  to  assist  in  plac- 
ing the  band.  If  the  teeth  are  crowded,  a  thin  spatula  pressed 
between  tliem  and  allowed  to  remain  for  a  few  moments  will 
provide  ample  space.  For  the  ligatures,  almost  any  of  the  usual 
materials  may  be  employed,  such  as  waxed  floss  silk,  strong 
linen  thread,  or  the  gut  ligature  so  extensively  employed  in 
surgery,  but  fine  copper  wire  (No.  26)  is  preferable  on  account 
of  its  strength,  pliability,  and  cleanliness. 


86 


THE    ANGLE    SYSTEM. 


That  the  reader  may  become  more  faniilicir  with  this  method 
of  treatment,  as  well  as  with  a  few  of  the  many  modifications 
of  which  it  is  susceptible,  reports  of  a  few  cases  from  practice 
are  subjoined,  with  illustrations  from  models  made  accurately  in 
each  instance  after  treatment. 

Case  I. — The  first  is  represented  by  Fig.  101. 

On  July  14,  1889,  Wm.  Fraley,  aged  forty-five,  was  admitted 
to  the  Minneapolis  City  Hospital.  A  blow  from  a  policeman's 
club  had  produced  one  simple  and  one  compound  fracture  of 
the  inferior  maxilla.  The  first  was  an  oblique  fracture  on  the 
right  side,  beginning  with  the  socket  of  the  second  bicuspid, 
extending  downward  and  backward,  and  involving  the  socket 
of  the  first  molar.     The  second  bicuspid  had  fallen  out,  and  the 

Fig.  101. 


first  molar  was  much  loosened.  The  second  molar  had  been 
lost  years  before,  while  the  third  molar  and  the  remaining  teeth 
were  much  abraded,  and  much  loosened  by  salivary  calculus. 
The  second  fracture  was  on  the  opposite  side,  high  up  in  the 
ramus  of  the  jaw\  I  could  not  detect  the  exact  course  the  line 
of  fracture  had  taken,  but  the  crepitation  of  the  ends  of  the 
bones,  and  the  pain  occasioned  thereby,  were  unmistakable  evi- 
dence of  a  fracture.  The  patient,  as  is  usual  in  such  cases,  was 
unable  to  close  his  jaws.  The  parts  on  the  right  side  were 
widely  separated,  and  the  anterior  piece  much  depressed  by 
reason  of  the  action  of  the  digastric  muscle,  the  posterior  piece 
of  bone  being  drawui  firmly  up,  and  the  molars  occluding  by 
reason  of  the  contraction  of  the  masseter  muscle.  He  was 
treated  as  follow^s : 

Bands  were  made  to  encircle  all  four  of  the  cuspids  (they  being 


TREATMENT    OF    FRACTURE.'^    OF    THE    MAXILL.E.  87. 

most  tirmly  attached  in  their  sockets).  The  fractured  ends  of  the 
bones  were  placed  in  careful  apposition,  and  the  lower  jaw- 
closed,  the  lower  teeth  being  correctly  occluded  with  the  upper. 

The  points  on  the  bands,  where  the  little  tubes  (C,  Set  No.  1) 
shown  in  the  engraving  should  be  attached,  were  carefully 
noted  and  marked.  The  bands  were  slipped  off  and  the  tubes 
soldered  to  them,  after  which  the  bands  were  cemented  in 
proper  position  upon  the  teeth,  and  two  small  traction-screws 
(B,  Fig.  1),  shown  in  the  engraving,  inserted  in  the  tubes.  The 
jaws  were  closed  and  the  nuts  tightened. 

During  an  attack  of  coughing  the  following  night,  one  of  the 
bands  was  loosened,  but  it  was  easily  replaced  the  next  day. 
No  further  accident  or  trouble  occurred,  the  patient  readily 
taking  nourishment  through  the  spaces  between  the  teeth. 
Thus  the  fractured  jaw  was  firmly  supported  without  motion 
for  twenty-two  days,  when  the  appliance  was  removed,  showing 
most  excellent  results. 

That  the  patient  was  a  great  lover  of  the  clay  pipe  is  shown 
in  the  engraving,  bythefmuch  worn  ends  of  the  lateral  incisors, 
which  resulted  from  holding  the  stem  of  the  pipe.  While 
wearing  the  appliance  he  was  not  debarred  from  his  favorite 
enjoyment,  although  compelled  to  grasp  the  stem  between  his 
lips  instead  of  the  teeth. 

Case  II. — December  28,  1889,  Thomas  Bremen  was  admitted 
to  the  Dental  Infirmary  of  the  University  of  Minnesota,  suffer- 
ing from  the  effects  of  a  blow  received  on  the  left  side  of  the 
jaw  from  a  cant  hook,  while  working  in  a  lumber  camp.  The 
result  was  two  fractures  of  the  jaw. 

The  first  fracture  was  on  the  right  side,  beginning  between 
the  first  and  second  bicuspids  and  extending  downward  and 
backw^ard  so  far  as  to  involve  the  lower  part  of  the  anterior 
root  of  the  first  molar.  The  second  was  on  the  leftside  directly 
through  the  angle  of  the  jaw  (see  Fig.  102).  The  accident  had 
occurred  thirty-two  days  previous  to  his  admission  to  the 
infirmary,  durino-  which  time  nothins:  had  been  done  to  reduce 
the  fracture.  He  reported  that  he  had  called  upon  a  physician, 
who  supposed  the  trouble  was  merely  an  abscessed  tooth,  and  had 
lanced  the  gum  with  a  view  of  reducing  the  swelling.  Later, 
the  patient  had  called  upon  a  dentist  in  one  of  the  smaller 
towns,  who  also  failed  to  diagnose  the  fracture,  and  extracted 
both  bicuspids  in  the  hope  of  giving  relief. 


88  THE    ANGLE    SYSTEM. 

Upon  examination  I  found  considerable  swelling  in  the  region 
of  the  fracture,  with  the  usual  result ;  the  patient  being  unable 
to  close  his  mouth,  by  reason  of  the  anterior  piece  of  the  frac- 
tured bone  being  drawn  down  by  the  depressor  muscles.  A 
false  joint  had  also  become  established,  and  could  be  easily 
moved  without  causing  pain.  At  the  fracture  of  the  right  side 
there  was  but  little  displacement;  the  swelling  also  was  slight. 

The  patient  was  anesthetized,  and,  with  a  view  to  breaking 
up  the  false  attachments  and  stimulating  activity  in  repair,  the 
ends  of  the  bones  rubbed  forcibly  together,  placed  in  perfect 
apposition  and  the  jaw  closed,  great  care  being  taken  to  articu- 
late the  teeth  correctly  with  the  upper  ones.  The  jaw  was  now 
firmly  bound  in  this  position  in  the  same  manner  as  described 

Fig.  102. 


and  shown  in  Fig.  99,  which  is  quite  as  efficient  and  much  easier 
to  adjust.  Four  bands  were  used,  encircling  the  four  cuspids, 
as  shown  in  Fig.  102.  The  bands  shown  upon  the  molars  in  the 
engraving  were  not  used,  as  I  found  them  unnecessary,  since 
the  jaws  were  firmly  supported  by  the  anterior  band  alone. 

Case  ISTo.  3  is  represented  by  Fig.  103,  and  is  that  of  a  healthy 
young  Swede,  twenty-two  years  of  age,  who,  while  washing 
windows,  had  fallen  from  the  second  story  to  the  hard  pave- 
ment. Besides  receiving  several  minor  injuries  he  sustained  a 
double  fracture  of  the  lower  jaw,  one  extending  from  between 
the  central  incisors,  and  one  posterior  to  the  second  molar,  the 
third  molar  having  been  extracted.  The  right  superior  lateral 
and  cuspid  were  knocked  out,  the  first  bicuspid  broken  off  near 
the  neck,  and  the  alveolar  process  badly  shattered.     The  cen- 


TREATMENT  OF  FRACTURES  OF  THE  MAXILL.E. 


89 


trals  and  left  lateral  were  bent  inward  and  forced  deeper  into 
their  sockets.  He  had  been  treated  by  the  attending  physician 
at  the  City  Hospital,  the  method  employed  being  that  of  the 
Barton  style  of  bandaging,  with  the  usual  result,  when  the  ban- 
dage is  employed  in  such  cases,  of  aggravating  the  condition  by 
forcing  the  pieces  inward  and  the  jaw  backward. 

Upon  examination  three  weeks  after  the  accident,  I  found 
much  displacement.  The  jaw  was  drawn  backward  and  the 
right  middle  section  of  the  bone  tipped  inward,  l^o  attention 
had  been  paid  to  the  bent  and  broken  condition  of  the  superior 
alveoli.  The  teeth  had  become  quite  firm  in  their  new,  but  ab- 
normal positions,  and  I  allowed  them  to  remain  so.     A  fibrous 

Fig.  103. 


attachment  had  been  established  in  the  lower  fracture,  which 
admitted  of  considerable  movement,  and  occasioned  but  little 
pain.  There  was  much  swelling,  and  pus  was  discharging  into 
the  mouth  from  the  anterior  fracture.  I  found  it  impossible  to 
restore  normal  occlusion  at  that  time.  Bands  were  made  to  en- 
circle the  four  bicuspids,  and  between  the  two  lower  bands,  on 
the  inside  of  the  mouth,  was  placed  one  of  the  jack-screws  (E 
and  J,  Set  'No.  1),  held  in  place  by  the  staple  and  spur  (E,  Fig. 
21,  and  B,  Fig.  20).  The  nut  was  tightened  until  the  piece  of 
bone  had  been  tipped  outward  about  one-half  the  distance  to 
its  normal  position,  but  the  operation  caused  so  much  pain  that 
further  movement  was  deferred.  The  jaws  were  then  closed 
and  the  buttons  connected  by  ligatures,  but  occlusion  was  far 
from  being  normal.  On  the  next  day,  by  again  tightening  the 
nut  on  the  jack-screw  and  with  renewed  ligatures  bound  very 


90 


THE    ANGLE    SYSTEM. 


tightly,  I  was  enabled  to  secure  nearly  the  normal  occlusion. 
On  the  third  day  following,  by  the  same  means,  correct  occlu- 
sion was  established.  The  jack-screw  was  allowed  to  remain  in 
position  to  steady  the  tipping  section. 

The  abscess  was  frequently  syringed  with  fresh  peroxid  of 
hydrogen.  A  few  fragments  of  bone  were  washed  out.  The 
fractures  readily  united,  and  on  the  twenty-seventh  day  the  jaw 
was  released  and  found  to  be  quite  firm. 

Case  ISTo.  4  shows  another  modification,  and  is  represented  by 
Fig.  104.  A  young  machinist  received  a  severe  blow  from  the 
fist  of  an  antagonist,  by  which  two  compound  fractures  were 
sustained;  one  posterior  to  the  first  molar,  the  other  in  the 
region  of  the  cuspid,  which  was  involved  and  greatly  loosened. 

Tig.  104. 


Occlusion  was  established  and  maintained  in  the  previously  de- 
scribed way.  Suppuration  occurred  in  both  fractures  on  about 
the  tenth  day,  and  received  proper  treatment.  The  union  of 
the  anterior  fragment  was  slow,  as  the  patient  was  troubled  by 
a  persistent  hacking  cough,  which  occasioned  a  slight  move- 
ment between  the  ends  of  the  bone,  just  sufficient  to  interfere 
with  the  healing  process.  On  the  twentieth  day  the  ligatures 
were  cut,  a  jack-screw  placed  in  position  between  the  bands  on 
the  inside  in  the  same  manner  as  in  Fig.  103,  with  an  additional 
ligature  firmly  connecting  the  two  buttons  on  the  lower  bands, 
and  resting  in  contact  with  the  labial  surfaces  of  the  interven- 
ing teeth.  This  additional  support  proved  successful;  the  union 
proceeded  slowly,  and  was  found  complete  when  the  bands  were 
removed  on  the  sixty-second  day  after  the  accident. 


TREATMENT  OF  FRACTURES  OF  THE  MAXILL.E. 


91 


Anotlier  modification  is  shown  in  a  somewhat  peculiar  case, 
represented,  in  Fig.  105.  The  patient,  a  man  of  about  forty 
years  of  age,  had  sustained  a  complete  fracture  of  the  left 
angle  of  the  jaw,  as  the  result  of  a  kick  from  a  horse.  The  jaw 
was  enormouslj^  large  and  protruding,  and  the  occlusion  so  un- 
usually faulty  that  I  was  at  a  loss  to  determine  what  the  patient's 
normal  occlusion  was  ;  but  upon  questioning  him,  he  informed 
me  that  when  a  boy  of  ten  years  he  had  been  hit  with  a  stone, 
causing  a  fracture  on  the  right  side  of  the  jaw,  which  had  been 
allowed  to  heal  without  any  treatment.  This  statement,  with 
the  worn  facets  upon  the  cusps  of  some  of  the  teeth,  and  the 
readiness  with  which  they  occluded  only  at  these  points,  showed 
conclusively  the  position  in  which  the  jaw  must  be  secured.      I 

Fig.  105. 


at  first,  of  coarse,  supposed  that  the  usual  number  of  four  bands 
and  two  ligatures  would  be  necessary,  but  I  found  the  single 
ligature,  as  shown,  was  quite  sufficient  to  firmly  retain  the  jaw 
in  this  abnormally  normal  position.  The  jaw  was  set  a  few 
hours  after  the  accident.  Very  little  swelling  ensued,  the  frac- 
tured parts  uniting  rapidly,  I  saw  the  patient  but  four  times, 
and  removed  the  bands  on  the  twentieth  day,  as  further  support 
seemed  unnecessary.  I  admonished  the  patient,  however,  to 
avoid  using  his  jaw  as  much  as  possible  for  at  least  ten  day^ 
thereafter. 

Fig.  106  represents  a  case  where  the  patient  suffered  in  a  rail- 
road wreck  two  compound  fractures  of  the  inferior  maxilla,  one 
on  each  side,  posterior  to  the  second  molar.     The  left  side  was 


92 


THE    ANKLE    SYSTEM. 


quite  badly  comminuted.  The  full  complement  of  teeth  was 
present,  with  the  exception  of  the  third  molars.  'Jlie  occlusion 
of  all  the  teeth  was  excellent.  The  incisors,  however,  were 
crossed  (not  well  shown  in  this  engraving);  that  is,  the  left 
superior  central  and  lateral  closed  just  inside  of  the  points  of 
the  lower  incisor  and  cuspid,  while  the  right  central  and  lateral 
closed  just  outside  of  the  points  of  the  opposing  lower  cuspid, 
central,  and  lateral. 

The  teeth  being  so  perfect  and  the  occlusion  so  accurate,  liquid 
foods  only  were  possible.  The  conditions  were  made  more  un- 
favorable on  account  of  the  patient  sufteringfrom  severe  spinal 
injury  received  at  the  time  of  the  accident,  but  with  the  excep- 
tion  of  considerable  suppuration  in  the  left  fracture,  which 

Fig.  106. 


yielded  readily  to  treatment,  nothing  unusual  occurred.  The 
ligatures  were  removed  on  the  fortieth  day,  and  excellent  results 
were  apparent. 

It  might  be  ur^ed  against  a  method  of  treatment  which  in- 
volves  the  closure  of  the  teeth  and  the  binding  of  the  jaws 
iirraly  together,  that  the  patient  would  be  unable  to  take  suffi- 
cient nourishment.  Experience,  however,  shows  that  this  argu- 
ment has  practically  no  foundation,  for  it  rarely  happens  that  a 
patient  is  found  without  some  missing  teeth,  thereby  providing 
al)undant  opportunity  for  the  inception  of  all  ordinary  chopped 
foods,  and  more  especially  for  the  large  number  of  foods  now 
available  in  liquid  form.  Even  when  all  the  teeth  are  sound 
and  in  perfect  position,  there  is  plenty  of  space  between  the 
teeth,  or  behind  the  molars  and  between  the  upper  and  lower 


TREATME>"T    OF    FRACTURES    OF    THE    MAXILLA. 


93 


incisors,  for  taking  all  the  nourishment  necessary.  Of  course, 
in  these  rare  cases  more  time  would  be  required  for  eating. 
This  inconvenience  is  very  slight  when  we  consider  the  advan- 
tages of  freedom  from  an  uncleanly,  bulky,  and  inconvenient 
apparatus  within  the  mouth,  often  accompanied  by  the  distig- 
urement  of  bandages  and  splints  without,  as  well  as  the  great 
importance  of  the  accuracy  in  results  which  it  assures,  so  un- 
certain of  attainment  in  many  other  methods  commonly  em- 
ployed. 

There  is  also  another  class  of  lesions  in  the  treatment  of 
which  this  plan  of  fixation  may  be  employed  to  great  advan- 
tage. I  refer  to  excision  of  the  lower  maxilla,  or  those  cases 
where  a  large  portion  of  the  jaw  has  been  removed,  as.  in  Fig. 
107. 

In  all  these  cases  there  is  a  strong  tendency  for  the  remain- 

Fiu.   107. 


ing  portion  of  the  jaw  to  be  drawn  greatly  to  one  side  (about 
three-quarters  of  an  inch,  by  actual  measurement,  in  the  case 
represented),  due  to  the  contraction  of  the  cicatricial  tissues 
following  the  healing  of  the  wound.  The  plan  I  propose  wmII 
prevent  this  contraction,  by  securing  the  remaining  portion  of 
the  jaw  in  proper  occlusion,  by  means  of  the  fracture-bands  and 
ligatures  in  the  manner  already  described.  The  jaw  thus  firmly 
held  will  exert  sutiicient  tension  upon  the  healing  muscles  to 
prevent  their  contraction.  I  would  also  suggest  the  advisability 
of  increasing  the  tension  by  the  attachment  of  a  plumper,  by 
means  of  a  clamp-band,  to  one  of  the  molars  in  the  upper  jaw  on 
the  side  from  which  the  section  has  been  removed,  allowino-  the 


94  THE    ANGLE    SYSTEM. 

shield  or  pluinper  to  extend  downward  and  outward,  to  occupy 
somewhat  the  position  of  the  missing  bone.  This  shield  may 
also  serve  a  useful  purpose  in  holding  in  better  position  the 
dressing  of  the  wound. 

The  next  plan  may  be  said  to  be  a  modification  of,  or  an  im- 
provement upon,  the  plan  advocated  by  Hippocrates  in  the  fifth 
century  B.C.,  and  which  has  been  employed  from  that  time  to 
this.  It  consists  in  holding  the  fractured  ends  of  the  bone  in 
apposition  by  wrapping  ligatures  about  the  teeth,  or,  as  physi- 
cians now  term  it,  wiring  the  teeth.  The  principal  disadvantage 
has  always  been  the  slipping  of  the  ligatures,  which  produced 
displacement  of  the  bones,  and  caused  inflammation  by  the 
pressure  of  the  sliding  ligature  upon  the  gums. 

My  plan  is  shown  iii  Fig.  108,  and  consists  in  encircling  suit- 


able teeth  with  fracture-bands  and  attaching  ligatures  to  the 
buttons  upon  the  bands,  so  that  loosening  of  the  bones  or  pres- 
sure upon  the  gums  is  impossible. 

A  modification  of  the  plan  is  shown  in  Fig.  109,  in  which 
additional  support  is  secured  by  connecting  the  labial  and 
lingual  wire  ligatures  by  loops  of  wire  passed  between  the 
teeth,  with  their  ends  united  by  twisting. 

In  favorable  cases,  as  in  simple  transverse  fractures  with  little 
or  no  displacement  and  where  the  teeth  are  very  firm,  if  the 
apparatus  is  adjusted  with  skill,  the  plan  will  be  found  valuable, 
as  it  is  ver}^  neat,  clean,  and  compact,  and  does  not  interfere 
with  the  freedom  of  the  jaw. 

A  few  suggestions  may  assist  the  inexperienced  in  the  adjust- 
ment of  the  apparatus,  so  that  it  will  surely  aflford  equal  pres- 
sure and  support  upon  the  intervening  teeth.     The  only  diffi- 


TREATMENT    OP    FRACTURES    OF    THE    MAXILLAE. 


95 


culty  is  in  regard  to  the  proper  leiii^'th  of  the  lingual  ligature 
when  completed.  This  is  easily  overcome  by  using  two  small 
copper  wires,  passing  respectively  above  and  below  the  buttons 
and  extending  beyond  them  a  half-inch  or  more  at  each  end. 
Tension  is  not  exerted  on  the  buttons  by  uniting  the  ends  by 
twisting  until  after  the  external  and  transverse  ligatures  have 

Fi(i.  109. 


been  completed.  The  engraving  is  incorrect  in  this  respect, 
that  only  one  end  of  the  lingual  ligature  shows  union  of  the 
ends,  instead  of  both. 

Fig.  110  represents  a  modification  of  this  plan  used  for  hold- 
ing in  position  a  large  section  of  the  alveolus,  including  the 
incisors  and  left  lower  cuspids,  which  had  been  broken  outward 

Fig.  110. 


as  the  result  of  falling  from  a  sled  while  the  individual  was 
coasting  with  the  knotted  end  of  a  rope  held  in  the  mouth. 
The  second  bicuspids  were  banded,  and  a  wire  ligature  made  to 
encircle  the  buttons  and  bear  against  the  loosened  teeth.  The 
ligatures  showed  a  slight  tendency  to  slide  down  and  impinge 
upon  the  gum,  but  this  was  easily  remedied  by  encircling  the 


96 


THE    ANGLE    SYSTEM. 


main  ligature  and  the  incisors  with  two  or  three  fine  wire 
ligatures,  thus  giving  additional  support  in  a  downward  direc- 
tion. 

Fig.  Ill  shows  another  plan  for  securing  fixation  which  pos- 
sesses several  valuable  features.  It  is  a  thin  metal  cap,  swaged 
to  fit  the  crowns  accurately  and  covering  a  sufficient  number  of 
'the  teeth  in  the  arch  to  aiford  the  necessary  support,  the  whole 
being  firmly  cemented  to  the  teeth  with  oxyphosphate  of  zinc. 
Copper,  gold,  silver,  aluminum,  or  vulcanite  may  be  used ;  my 
preference  is  aluminum.  The  plan  is  excellent,  in  that  it  allows 
freedom  of  the  jaw,  is  very  clean  and  compact,  and  retains  the 
fractured  ends  of  the  bone  firmly  in  apposition.  Considering 
the  simplicity  of  this  appliance,  and  the  familiarity  of  dentists 

Fig.  111. 


with  oxyphosphate  of  zinc,  it  is  surprising  that  the  value  of  this 
idea  in  treating  fractures  has  not  been  before  recognized;  but  I 
find  no  record  of  its  use,  although  dentists  frequently  use  similar 
splints  in  the  retention  of  teeth  after  they  have  been  regulated, 
and  Hullihen  employed  a  similar  device  in  1848  to  hold  the  sec- 
tion of  a  jaw  after  a  surgical  operation,  using  ligatures  to  keep 
the  appliance  in  place. 

For  several  years  I  supposed  I  had  been  the  first  to  employ 
this  method  of  retaining  fractures,  but  I  now  believe  it  was  first 
used  by  Dr.  John  H.  Martindale,  of  Minneapohs,  who  preceded 
me  a  year  or  so,  by  cementing  in  position  a  splint  made  after 
Kingsley's  pattern,  in  order  to  dispense  with  the  submental  cap 


TREATMENT    OF    FRACTURES    OF    THE    xAIAXILLvE. 


97 


and  bandages,  which  would  interfere   with  the  treatment  of 
serious  external  wounds  on  the  side  of  the  face. 

My  first  case  treated  after  this  method  is  shown  in  Fig.  112. 
Michael  P.,  a  baker  by  trade,  had  fallen  down-stairs,  knocking 
out  the  superior  incisors,  cuspids,  and  one  bicuspid,  also  loosen- 
ing the  lower  central  incisors  and  fracturing  the  jaw  at  the 
symphysis.  As  I  remember,  he  also  received  a  fracture  of  one 
of  the  femurs.  He  was  admitted  to  the  Minneapolis  City  Hos- 
pital some  time  in  June,  1888.  I  saw  him  first  som_e  two  months 
after  the  accident  occurred,  during  which  time  the  attending  sur- 
geon had  employed  the  Barton  style  of  bandaging  in  treatment. 
Union  of  the  bone  had  not  taken  place;  on  the  contrary,  a  com- 
plete fibrous  joint  had  been  established,  Avith  the  ends  of  the 

Fig.  112. 


bones  more  or  less  absorbed  and  rounded,  admitting  of  a  free 
hinge  movement,  with  pus  discharging,  for  which  a  large  rubber 
drainage-tube  had  been  inserted.  The  tube  was  removed,  the 
wound  thoroughly  washed,  and  an  impression  taken  w^ithout  any 
attempt  at  changing  the  collapsed  condition  of  the  sides  of  the 
arch.  A  model  was  made  and  sawed  through  at  the  point  of 
fracture.  It  was  then  placed  in  the  articulator  and  adjusted  to 
restore  the  original  occlusion  as  nearly  as  possible.  Over  this 
readjusted  model  a  very  thin  vulcanite  splint  was  formed,  the 
outlines  of  which  corresponded  to  the  dotted  lines  in  the  en- 
graving. 

The  first  attempt  at  cementing  it  in  position  upon  the  teeth 
was  unsuccessful,  the  cement  hardening  too  rapidly,  but  the 
next  proved  successful.    The  splint  remained  in  position  without 

7 


98 


THE    ANULE    SYSTEM. 


any  trouble  for  nearly  four  months, -when  it  worked  loose,  and 
we  found,  upon  examination,  that  firm  union  had  taken  place. 

Of  course  the  range  of  usefulness  of  this  splint  is  quite 
limited,  as  a  sufficient  number  of  firm  teeth  must  be  present  on 
each  side  of  the  fracture.  Its  principal  value  will,  I  think,  be 
found  in  treating  fractures  in  the  anterior  part  of  the  jaw,  more 
especially  in  that  class  of  cases  resulting  from  gunshot  wounds 
in  which  large  sections  of  the  alveolus  have  been  carried  away. 

Another  plan  which  I  have  made  use  of  in  a  few  favorable 
cases  with  much  satisfaction  is  shown  in  Fig.  113,  which  repre- 
sents my  first  case  treated  by  the  method  in  question.  On 
May  29,  1889,  a  young  man  of  twenty-one  years  was  admitted 
to  the  St.  Anthony  Hospital  of  Minneapolis.  During  an  attack 
of  epilepsy  he  had  fallen  from  a  lumber  pile  to  the  ground,  a 
distance    of    fifteen  or  twenty  feet.     Besides  receiving  severe 


Fig.  113. 


\    i 


bruises,  lie  sustained  a  compound  fracture  at  the  symphysis,  ter- 
minating in  front  between  the  central  and  latera,l,  as  shown  by 
the  line  in  the  engraving.  The  fractured  bone,  when  first  seen, 
was  quite  widely  separated  at  the  top,  and  the  left  central  incisor 
was  much  loosened.  He  was  treated  as  follows :  The  ends  of 
the  fractured  bones  were  carefully  placed  in  position  and  tempo- 
rarily fastened  by  lacing  the  teeth  together  with  silk  ligatures. 
The  cuspids,  being  very  firm,  were  carefully  fitted  with  plain 
bands.  Tubes  were  soldered  to  these  bands  horizontally.  Tlie 
large  traction-screw  shown  at  A,  Fig.  1,  was  now  slipped 
through  the  tubes,  and  the  bands  were  firmly  cemented  in  posi- 
tion upon  the  teeth.  The  nut  was  then  turned  upon  the  screw 
until  the  fractured  ends  of  the  bones  were  drawn  snugly 
together.  I'his  appliance  was  worn  without  displacement  or 
further  troul)le  for  twenty-one  days,  when  it  was  removed,  the 
bones  haN-inii;  l)Ccome  firmlv  united. 


FINAL    SUdUKSTJONS    ON    FRACTURES.  99 

I  may  add  that  during  the  time  the  appliance  was  worn,  so 
iirmly  was  the  jaw  supported  that  the  patient  suffered  but  little 
inconvenience,  and  after  the  third  day  partook  regularly  of  his 
meals,  using  his  jaws  freely,  but  of  course  avoiding  the  very 
hard  foods. 


CHAPTER   II. 

FINAL    SUGGESTIONS    ON    FRACTURES. 

In  adjusting  bands  for  the  treatment  of  a  fracture,  carefully 
consider  the  direction  in  which  to  exert  the  proper  pressure  for 
securing  the  jaw.  It  usually  happens  in  cases  of  fracture  that 
the  muscles  in  contracting  tend  not  only  to  depress  the  jaw,  but 
to  draw  it  backward,  especially  if  the  fracture  be  in  the  region 
of  the  last  molar.  Consequently  such  teeth  for  anchorage 
should  be  selected  as  shall  use  pressure  not  only  upward  but 
forward,  as  in  Fig.  105. 

This  is  only  a  general  rule,  however,  but  I  would  specially 
advise  that  the  direction  of  force  necessary  in  each  casj  should 
be  carefully  considered,  and  then  the  bands  and  l)uttons  be 
adjusted  accordingly. 

Sometimes  it  is  an  advantage  to  band  more  than  one  tooth  in 
order  to  distribute  the  power  exactly  in  the  direction  necessary. 
Should  anj'  of  the  teeth  which  have  been  selected  for  anchorage 
show  a  tendency  to  elongation,  the  bands  should  be  shifted  to 
other  teeth,  or  the  direction  of  the  force  be  changed.  In  but 
two  instances  have  I  noted  this  complication,  and  I  am  inclined 
to  believe  that  one  of  the  cases  was  due  to  the  band  slipping 
and  impinging  upon  the  gum,  and  thus  probably  producing  the 
same  result  as  when  a  ligature  is  carelessly  left  about  the  tooth. 

Should  it  be  found  advisable  to  employ  the  plan  illustrated  by 
Fig.  112  or  Fig.  113  in  the  treatment  of  a  case,  it  will  sometimes 
be  found  an  advantage  to  support  the  jaw  by  the  first  }tlan  (Fig. 
99),  for  a  few  days,  or  until  the  wounds  are  in  more  favorable 
condition  for  taking  an  impression  or  adjusting  the  apjiaratus. 

After  the  jaw  has  been  properly  set,  the  muscles  relax  in  a 
few  liours  so  that  the  strain  upon  the  ligature  and  anchor-tooth 
is  slight. 


100  THE    ANGLE    SYSTEM. 

Very  often  patients  receive  severe  bruises  and  internal  injuries 
at  the  time  the  fracture  is  sustained,  and  these  may  occasion 
vomiting,  more  or  less  violent.  Therefore  especial  caution 
should  be  observed  that  the  securing  of  the  jaw  be  delayed  until 
all  tendency  to  nausea  has  subsided.  Be  in  no  haste,  for  1  know 
of  no  ill  eflects  from  a  few  hours'  or  even  days'  delay  in  setting 
a  fracture.  Should  it  be  advisable  to  immediately  set  the 
fracture,  it  might  be  well  to  provide  the  attendant  with  a  pair 
of  strong  scissors  to  cut  the  ligatures  if  symptoms  of  nausea 
develop. 

'  It  should  require  but  little  argument  to  impress  the  impor- 
tance of  extreme  cleanliness  about  the  mouth  during  the  treat- 
ment of  fractures.  Frequent  rinsing  of  the  mouth  with  proper 
antiseptic'solutions  should  be  insisted  upon.  If  the  fracture  is 
more  or  less  comminuted,  as  is  frequently  the  case,  suppuration 
may  be  expected.  The  plan,  then,  which  has  been  most  success- 
ful with  me,  is  extra  cleanliness  of  the  wound  by  frequent  injec- 
tions of  pure,  fresh  peroxid  of  hydrogen  with  a  suitable  syringe. 
The  patient  or  the  attendant,  with  a  little  experience,  can  accom- 
plish this  quite  as  well  as  the  surgeon.  Patience  and  persist- 
ence in  this  line  will  soon  cause  the  necrotic  fragments  to  be 
washed  out.  Only  in  one  instance,  in  my  experience,  has  it 
seemed  necessary  to  interfere  with  the  wound  by  scraping  the 
bone  with  instruments. 

While  the  patient  is  undergoing  treatment,  his  general  health 
should  also  not  be  allowed  to  become  impaired.  Plenty  of  exer- 
cise in  the  open  air,  if  other  injuries  do  not  prevent,  should  be 
insisted  upon,  as  well  as  a  requisite  amount  of  nourishing  food, 
and  the  surgeon  should  occasionally  inspect  the  bands  and  liga- 
tures, to  see  that  they  are  in  order,  so  that  the  jaw  shall  not  be 
allowed  to  get  loose,  admitting  movement  between  the  frac- 
tured ends  of  the  bones.  Should  one  of  the  bands  become 
broken,  it  should  be  replaced  as  quickly  as  possible.  No  special 
harm  will  come  from  cutting  the  ligatures  and  separating  the 
jaws,  for  the  purpose  of  replacing  it. 

In  cases  where  a  section  of  the  bone  shows  a  tendency  to 
lean,  so  that  the  teeth  do  not  properly  occlude,  a  finger  of  metal, 
made  to  bear  against  a  tooth  in  the  leaning  section  and  soldered 
to  a  band  encircling  some  fiivorably  located  anchor-tooth,  will 
effectually  restore  the  proper  occlusion. 

In  like  manner  the  range  of  application  of  this  method  ot 


FINAL    SUGGESTIONS    ON    FRACTURES.  10  L 

retaining  fractures  may  be  extended  to  cases  where  fractures 
occur  in  the  body  of  the  bone  and  the  molars  are  absent.  The 
edentulous  portion  of  the  jaw  may  be  securely  held  in  proper 
position  by  a  prop  made  to  bear  against  the  section  of  bone,  and 
kept  in  place  by  attachment  to  a  band  secured  about  one  of  the 
molars  or  bicuspids  in  the  upper  jaw. 

The  methods  so  far  offered  will,  I  believe,  nearly  cover  the 
entire  range  of  cases  requiring  treatment.  There  still  remains, 
however,  one  distinct  class  for  consideration,  namely;  the  eden- 
tulous patient.  Fortunately,  patients  of  this  class  requiring 
treatment  are  exceedingly  rare,  and  probably  the  best  plan  is 
the  Gunning  splint,  or  what  is  the  same  in  principle,  attaching 
together  by  wire  or  vulcanite  the  artificial  dentures,  should  the 
patient  possess  them. 

The  cases  of  fractures  so  far  described  have  been  confined  to 
the  inferior  maxilla.  The  methods,  however,  of  securing  fixa- 
tion are  all  more  or  less  applicable  to  the  treatment  of  fractures 
in  the  upper  jaw  as  well,  though  I  believe  the  one  first  described 
is  most  applicable ;  for  the  reason  that,  if  one  of  the  superior 
maxillary  bones  is  fractured,  it  will  be  more  or  less  displaced 
and  usually  forced  downward.  After  carefully  replacing  the 
pieces,  the  jaws  are  closed  and  the  teeth  articulated,  and  the 
pieces  thus  supported  and  held  upward  in  position  by  the  lower 
jaw  secured  in  the  usual  way  by  bands,  buttons,  and  ligatures, 
attached  on  the  uninjured  side. 

Finally,  as  all  the  apparatus  possessing  an}^  special  merit  in 
the  treatment  of  fractures  of  the  maxillse  have  been  invented 
by  dentists,  and  their  familiarity  with  the  parts,  special  knowl- 
edge of  mechanics,"  and  facilities  at  their  command  fit  them 
above  all  other  surgeons  for  this  work,  I  would  recommend  that 
the  different  dental  societies  throughout  the  country  shall  secure 
appointments  of  competent  dentists,  in  all  hospitals,  for  the  treat- 
ment of  these  lesions,  for  to  them  this  special  line  of  surgery 
justly  belongs. 


102         DK.    EDWARD    H.    ANGLE'S    REGULATING    IMPLEMENTS. 

SET  No.  1. 

Patented  March  5,  1889. 


PRICES. 
Set  No.  I,  complete  (including  100  page  descriptive  Book) 


PARTS    SEI'AK.VTR  : 

Traction  Screw  "A"  and  "  D"  . 
"      "B"  and  "  C"  . 
Jack-Screw  "E"  and  "J" 
Coils  of  Band  Material  "  F"  and  "  H" 
Retaining  Wire  "  G" 


Rotating  Levers  "  L" 
Retaining  Pipes  "  R" 
Wrench 


•     1.25 

1. 00 

.     r.oo 

each       .50 

.50 

per  Yz  doz.       .25 

set  of  ten       .75 

each       .15 


EXTRA  PARTS. 

Adjustable  Clamp  Bands  for  Bicuspids  and  Molars. 
Fig.  I.  Fig.  2.  Fig.  3.  Fig.  4. 


bicuspid. 


Bicuspid. 


Molar. 


PRICES. 


Adjustable  Bands  Nos.  i  and  2 eacli  %i.oo 

"         Fracture  Bands  Nos.  3  and  4 '        i.io 

THE  S.  S.  WHITE  DENTAL  MEG.  CO.,  Sole  Agent. 


DK.    EDWARD    H.    ANULE  S    REGULATING    IMPLEMENTS. 


103 


SET  No.  2. 

Patented  Nov.  6,  if 


PRICES. 
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PARTS   SEPARATE : 

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Wire  Arch  "B" 

Anchor  Band  and  Pipes  "  D,"  complete 
Coils  of  Band  Material 
Heavy  Elastic  Bands  .  .       " . 

Wrench        .         . 

EXTRA  PARTS. 

Head  Gear. 


.  I6.50 

each     2.00 

r.50 

1.50 

.50 

set  of  six      ..40 

each       .  15 


PRICE. 

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(The  cut  shows  the  Tr.iction  Bar  "A"  ;  not  included  in  price. 

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104 


DR.    EDWARD    H.    ANGLE'S    REGULATING    IMPLEMENTS. 


EXTRA  PARTS. 

Chin  Retractor. 


PRICE. 
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each  $2.50 


PRICE. 


Expansion  Arch 


each  $1.50 


Dr.  Edward  H.  Angle's  Appliances. 


For'the  information  of  those  not  ah'eady  familiar  with  these  widely  known 
and  approved  ready-made  appliances  for  teeth  regulation  and  retention  and 
the  reduction  of  jaw-fractures,  the  100  page  book  supplied  with  each  full  set 
as  here  illustrated  contains  instructions  with  cuts  showing  practical  cases  and 
carefully  covering  in  detail  the  methods  for  the  easy  adaptation  of  these  ap- 
pliances to  either  the  simplest  or  most  complicated  cases  arising  in  practice. 
On  the  other  hand,  the  most  expert  practitioners  will  find,  in  this  fourth 
edition,  new  matter  and  methods,  profusely  illustrated  and  described.  The 
book  should  be  a  manual  for  ready  reference  in  every  dental  office  and  labor- 
atory. 


Fourth  Edition,  in  Paper  Cover  ....'... 
"  Cloth 

THE  S.  S.  WHITE  DENTAL  MFG.  CO.,  Sole  Agent. 


I0.75 

I. CO 


DR.    EDWARD    H.    ANGLE's    REGULATING    IMPLEMENTS.  105 


(See  Fig.  8  B,  and  pages  20  and  4S. 

Regulating-  Pliers. 


(See  Fig.  8  B,  and 
page  15.) 

Band  Driver. 


Price,  20  cents. 


(See  Fig.  8  A,  and 
page  20. ) 

Annealing  Pliers. 


If 


No.  12. 
Price,  70  cents. 


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THE  S,  S,  WHITE  DENTAL  MFQ.  00, 


106  DR.    EDWARD    H.    ANGLE'S    REOULATINO    IMPLEMENTS. 


(See  Fig-.  8  B,  and  page  15. )  (See  Fig.  8  A,  and  page  17.) 

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Solder 
Tweezers  "A." 


Price 


No.]. 


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1 


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"      Curved  .    "      "         .85 

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DR.    EDWARD    H.    ANGLE'S    REUULATlXfi    IMl'LEMKXTS.  107 


(See  Fig.  8  A,  and  page  20.)  (See  Fig.  8  A,  and  page  79.  ) 

Solid  Steel  Cutting"  Nippers.    Spring  Wire  Coiler  and  Bender. 


Price  .     "^.  each  I1.75 

(See  Fig.  8  B,  and  "page  21.)*.?^  ,; 

No.  4  Herapath  Blow-Pipe. 


X 


Price,  Plain       .         .       per  pair  fo.So 
"       Nickel-plated  "  i.oo 


Price 
See  Fig.  8  B,  and  page  20. 


each  ^^3.75 


Melotte's  Combination  Anvil  and  Bench-Block. 

P'atented  Sept.  13,  !Sq2. 


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108  DR.    EDWARD    H.    AiS'GLE's    REGULATING   IMPLEMENTS. 


Laboratory 
How's  Crown  Pliers.  and  Office  Pliers. 

(See  Fig.  8  A,  and  pages  17  and  20." 


Wo.  10.  No.  11. 


Nos.  10  and  11,  straight  and 
curved  Pliers  for  bending  pins 
over  posts  in  Dr.  How's  pro- 
cess of  mounting  artificial  tooth- 
crowns. 

PRICES. 
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Straight  .         .         .  $1.50 
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Curved    .         .         .    1.75 


A  pair  of  neat,  well-made 
long-nose  Pliers,  which  find 
many  uses  in  office  and  labora- 
tory. Steel  throughout ;  nick- 
eled all  over. 


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DR.    EDWARD    H.    ANGLE'S    REGULATING    IMPLEMENTS,  10^ 

ANGLE'S  IMPRESSION  TRAYS. 

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UPPER,  Nos.  21,  22,  and  23. 


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110  DR.    EDWARD    H.    ANGLE'S    REGULATING    IMPLEMENTS, 


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DR.    EDWARD    H.   ANCLE's    RECT  r.ATI  \<.    I.Ml'I.EMEM.S.  Ill 

ANGLE'S  IMPRESSION  TRAYS. 

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112         DR.    EDWARD    H.    ANftLB's    REGULATING    IMPLEMENTS. 


ANGLE'S  IMPRESSION  TRAYS. 

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COLUMBIA  UNIVERSITY  LIBRARIES  (tisLstx) 

RK  521  An4  1895  C.1 

The  Angle  system  of  requlation  and  reten 


2002369621 


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